Free Health & Safety Recommendation Form Template
Health & Safety Recommendation Form
Personal Information
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Employee Name: |
[Your Name] |
|
Job Title: |
[Position] |
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Department: |
[Operations] |
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Date: |
[Month Day, Year] |
Observation Details
|
Location/Department: |
[Production Area] |
|
Description of Observation: |
Noticed a loose electrical wire hanging near Machine #3. |
|
Date and Time of Observation: |
[Month Day, Year], [Time] |
Recommendation Details
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Nature of Recommendation: |
Hazard |
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Recommended Action: |
Secure and repair the loose electrical wire to prevent potential electrical hazards. |
|
Priority Level: |
High |
Follow-up Actions
|
Actions Taken: |
Safety team notified; electrical maintenance scheduled for [Month Day, Year]. |
|
Responsible Person: |
Maintenance Supervisor |
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Target Completion Date: |
[Month Day, Year] |
Review and Approval
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Reviewed by: |
[Name, Job Title] |
|
Review Date: |
[Month Day, Year] |
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Approval Status: |
Approved |
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Comments (if any): |
Ensure to conduct a follow-up inspection after the maintenance. |
