Recordable Incident Presentation GLOBALEHSFO104 Incident Number YearMonthDaySite Brief
Recordable Incident Presentation GLOBAL-EHS-FO-104 Incident Number (Year-Month-Day-Site)
Brief Description Incident Number Please see GLOBAL-EHS-WI-105 Recordable Incident Presentation Instructions for details Description: This recordable incident investigation presentation must be sent to Global Director of EHS within 72 hours of a recordable incident occurrence. Page 2 - 10/10/2019 - Confidential, do not share without authorization - © All Rights Reserved FOR INK SAVING CLICK HERE BEFORE PRINTING
Investigation Pictures Picture 1 : Description Picture 2 : Description Page 3 - 10/10/2019 - Confidential, do not share without authorization - © All Rights Reserved FOR INK SAVING CLICK HERE BEFORE PRINTING
Injury / Treatment Details Describe Injury and Treatment received If possible, show a photograph of the injury to the worker and describe treatment given Page 4 - 10/10/2019 - Confidential, do not share without authorization - © All Rights Reserved FOR INK SAVING CLICK HERE BEFORE PRINTING
5 WHYS (Action, Condition and/or System that created or enabled the injury) Why did the accident happen? Enter Text Here Define the problem. Enter Text Here Why? Root Cause Analysis Enter Text Here Page 5 - 10/10/2019 - Confidential, do not share without authorization - © All Rights Reserved FOR INK SAVING CLICK HERE BEFORE PRINTING
Root Cause(s) Type Root Cause(s) in this section. Root Cause Immediate Corrective Action Page 6 - 10/10/2019 - Confidential, do not share without authorization - © All Rights Reserved Due Date Permanent Corrective Action FOR INK SAVING CLICK HERE BEFORE PRINTING Due Date
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