Risk Identified
Choose One...
YES
NO
NA
Near Miss
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YES
NO
NA
Minor/No Lost Workday Case
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YES
NO
NA
Major/Lost Workday Casl
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YES
NO
NA
Fatality
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YES
NO
NA
Struck by
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YES
NO
NA
Trip
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YES
NO
NA
Fall
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YES
NO
NA
Over Exertion
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YES
NO
NA
Slip
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YES
NO
NA
Stuck in Lift
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YES
NO
NA
Exposed
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YES
NO
NA
Occupational illness
Select On roll
Property management
Tenant
On roll
Select Contractual
Property management
Tenant
Contractual
Select Vendor of
Property management
Tenant
Vendor of
Select Visitors
Property management
Tenant
Visitors
Details of the injured person
Details of the type of emergency*
Power
Water
A/C
Lift
Fire system FAS/FPS
Service failure
Chemical/ /Oil Spill
Pollution
Refrigerant Leak
Emission
Land contamination
Water Contamination
Environmental
Fire
Explosion
Struck by or Against
Accident
Others
Property Damage
Intrusion
Arson
Theft
Vandalism
Hoax cal
Accident
Others
Security
Common Area
Client trial
Food trial
Basements
Food trial
Neighbouring building/area
Major
Minor
False Alarm
Manual Call Point Activated
Flow Switch activated
Fire
Fire in major part of the building
Fire in part of the building
Impact
Unsafe Condition
Unsafe Act
Incident Attribution