Unsafe Acts And Conditions Report
Name
*
Nombre
Apellido
Date
*
-
Día
-
Mes
Año
Fecha
Area
*
Type Of Situation
*
Unsafe Act
Unsafe Condition
Describe the situation in detail indicating, Where, When, How, Why and the people involved and the consequences
*
Places where it occurs:
*
Factors Involved in the unsafe act or condition
*
Machines
Equipment
Protection elements
Other Safety devices (Guards, operation commands, etc.)
Behavior, Attitude and other human factors
Locative conditions
Enviromental conditions (light, temperature, ventilation)
Possible Consequences
*
Accident
Incident
Other
Enviar
Should be Empty: