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.

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