SAFETY OBSERVATION FORM
Name of Reporting Person
*
Employee Code
*
Employee Category
*
Select
Staff
Company Worker
Contractor Worker
Department
*
Select
ACCOUNTS
BM-4 CONVERTING
BUSINESS EXCELLENCE
CIVIL
COMMERCIAL
CONVERTING & FINISHING PM-2
CONVERTING & FINISHING PM-3
ELECTRICAL BP
ELECTRICAL EP
ENGINEERING
ENVIRONMENT
GENERAL ADMINISTRATION
HR
INSTRUMENTATION BP
INSTRUMENTATION EP
IT
MECHANICAL BP
MECHANICAL EP
OPERATIONS
PLANNING & DELIVERY
POWER PLANT
PROCESS - BP
PROCESS-EP
PURCHASE
QA-BP
QA-EP
QA-EXISTING
RAW MATERIAL
SAFETY
SECURITY & FIRE
STORES
WARE HOUSE & DESPATCH
Mobile Number
*
Email Address
Area of Observation
*
Select
132KV GRID / REFRIGERATION & AIR CONDITIONING
ADMIN & ACCOUNTS BUILDING
AUTOMOBILE / CENTRAL WORKSHOP / REFRIGERATION & AIR CONDITIONING
BOARD MILL - MACHINE BUILDING & CCK
BOARD MILL -CONVERTING / WARE HOUSE & DESPATCH
BOARD MILL WASTE PAPER GODOWN1,2,3
CANTEEN / MESS / FIRST AID / MAIN GATE
CENTRAL STORE / SCRAP YARD / DIESEL PUMP
CONTROLL PANEL ROOMS & TRASFORMERS ( ALL PLANTS)
DIP-3
ETP
HR / IT / COLONY / GUEST HOUSE / ALL WASH ROOM
LAB - BOARD MILL
LAB-EXISTING
LOVELY GODOWN - (WASTE PAPER & CHEMICAL)
PM 1 & 2- CONVERTING & FINISHING GODOWN
PM-1 / DIP-1
PM-2
PM-3
PM-3 CONVERTING & FINISHING GODOWN
POWER PLANT & CHP
RAWMATERIAL GODOWN - PM 1 & 2
RAWMATERIAL GODOWN - PM 3 & SORTING PLANT
ROADS, PARKING ,WEIGH BRIDGE & BOUNDRY WALL
SFT
Exact Location
Priority
*
Select
Low
Medium
High
Type of Observation
*
Unsafe Condition
Near Miss Incident
Unsafe Act
Brief Observation
*
Date
*
Time
*
Select Time
Upload Photo
*
Submit
