OHS DATA FORM

1
Date of Incidents* This field is required.
Date
Year
Month
Day
2
Time of Incidents* This field is required.
1
2
3
4
5
6
7
8
9
10
11
12
Hour
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
Minutes
AM
AM
PM
3
Location of incident* This field is required.
4
Name of company/contractor under complaint* This field is required.
5
Details of complaint* This field is required.
Huge
Large
Normal
Small
Ok
Ok
6
Photo/video/audio/other attachments
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
7
Would you like to give us your Contact Information* This field is required.The personal data provided will be used for the purposes relating to the administration of the Factories and Industrial Undertakings Ordinance, Occupational Safety and Health Ordinance and other legislation administered by the Labour Department.
YESNO
8
Phone NumberPlease proceed if you selected No in the previous menu
Please enter a valid phone number.
9
Email
example@example.com
10
SignatureThis is to confirm the Authenticity of the information provided
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