Health & Safety Recommendation Form
Health & Safety Recommendation Form
Personal Information
Employee Name: |
[Your Name] |
Job Title: |
[Position] |
Department: |
[Operations] |
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
Nature of Recommendation: |
Hazard |
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 |
Target Completion Date: |
[Month Day, Year] |
Review and Approval
Reviewed by: |
[Name, Job Title] |
Review Date: |
[Month Day, Year] |
Approval Status: |
Approved |
Comments (if any): |
Ensure to conduct a follow-up inspection after the maintenance. |