SmartCheck | COMPUTERISED MAINTENANCE MANAGEMENT SYSTEM

Report Incident

Document No^*

Select Department^*

Select Asset^(Optional)

Select Sub Asset^(Optional)

Incident No^*

Site/Property/Building^*

Location of incident^*

Date of report^*

Report No

Date of incident^*

Type

Time of incident^*

12 hours format

Equipment Make

Serial No

Describe how the incident occurred?

Incident Category

1. Electrical Incident

2. Mechanical Incident

3. Near miss incident

4. Security Incident

5. Traffic Incident

6. Health & Safety Incident

7. Environmental Degradation Incident

8. Natural Incident

9. Theft cases

10. Complaint

11. Aggression/bullying

12. Emergency

13. Threats

14. Others(specify)

Severity of the incident

Immediate Correction Action Taken

Root Cause Analysis

	Immediate Impact of the incident
	SNO	Nature of Impact -PropertyLoss/Damage/Injury	Remarks

	Immediate Action Closure
	SNO	Action	Status

Remarks: (Please attach supporting reports, documents and images in support of corrective action closure):

Prepare detailed Incident Investigation Report

	Persons Involved in Root Cause Analysis Process
	SNO	Name	Designation	Signature

Reporting

Name:		Date:

Security / Property Manager

Name:		Date:

Attachment1

Attachment2

Attachment3

Attachment4

Attachment5