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Standard HSE - 104719

The document outlines a standard format for Health, Safety, and Environment (HSE) reports, detailing sections such as report information, incident details, immediate actions taken, root cause analysis, corrective and preventive actions, attachments, and signatures. Each section specifies the necessary information to be included, such as the type of event, description, and responsible persons. This template aims to ensure comprehensive reporting and analysis of safety-related incidents.

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17 views2 pages

Standard HSE - 104719

The document outlines a standard format for Health, Safety, and Environment (HSE) reports, detailing sections such as report information, incident details, immediate actions taken, root cause analysis, corrective and preventive actions, attachments, and signatures. Each section specifies the necessary information to be included, such as the type of event, description, and responsible persons. This template aims to ensure comprehensive reporting and analysis of safety-related incidents.

Uploaded by

frankimochi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Standard HSE (Health, Safety, and Environment) report format

HSE REPORT TEMPLATE


1. Report Information

 Report Title: (e.g., Near-Miss Report, Incident Report, Safety Observation)


 Date & Time of Report:
 Reported By:
 Department / Site Location:
 Job / Activity in Progress:

2. Incident / Observation Details

 Date & Time of Incident / Observation:


 Location:
 Type of Event:

o Incident

o Near Miss

o Unsafe Act

o Unsafe Condition

o Environmental Concern

o Other: ___________
 Description of Event:
(Provide a clear and concise description of what happened or was observed.)

3. Immediate Actions Taken

 Describe any first aid, emergency response, or mitigation actions taken


immediately after the event:

4. Root Cause Analysis (if applicable)


 Preliminary Cause(s):
(Use “5 Whys” or similar method if needed.)
 Contributing Factors:
(Human, equipment, environmental, procedural, etc.)

5. Corrective & Preventive Actions

 Actions Taken or Proposed:


 Responsible Person(s):
 Deadline for Completion:
 Follow-up Required: [ ] Yes / [ ] No
 Follow-up Date:

6. Attachments

 Photos

 Witness Statements

 Risk Assessment

 Other: ___________

7. Signatures

 Reporter Signature:
 Supervisor/Manager Review:
 HSE Department Review:

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