Date the incident occured
*
Please supply the date at which the incident took place.
Time the incident occured
*
Please supply the time the incident occured (Format: 24:00)
Where were you?
*
Enter details of the Depot, worksite or location you were at the time.
Describe what you saw and what could possibly have happened.
*
Please provide as much information possible
What were you able to do about it?
*
Please tell us what actions you took
Please try to categorise this close call
*
As best you can, try to assign this close call to a category
Environmental
Security
Site Welfare, Site Housekeeping
Personal Protective Equipment (PPE)
Process Document
Tools & Equipment
Public Protection
Traffic Management
Personal Health
Moving Plant & Machinery
Electrical Safety
Excavation Safety
Waste
Safe Systems of Work (SSoW) Planning
Possession Paperwork
Life Saving Rules
Other
Name
Name and surname
Telephone Number
The best number to call you on
Email
Department
*
Your the Department you are Working for
Crossrail East
Crossrail West
Head Office
OHL - Construction
OHL - Isolations
P/WAY
Possession Management - Anglia
Possession Management - LNW Central
Possession Management - LNW North
Possession Management - LNW South
Projects
SHEQ
Principal Contractor
*
Who is the principal contractor (Where relevant)
Weather
Falling Rain
Fine / Fair
Dull / Overcast
Bright Sunlight
Falling Snow
Mist / Fog
Indoor / Undercover
High Wind
Lightning Storm
Visibility
Less than 200 yards
More than 200 yards
Temperature (in Degrees)
Below -10
-10 to -1
0 to 10
11 to 20
21 to 30
31 to 40
Lighting
Daylight
Night
Darkness
No artificial light
Hand/Lamp torch
Floodlight
Fluorescent
Electric Bulb
Other
Underfoot Conditions
Ballast
Brick / Paving
Carpet
Concrete
Earth
Glass
Wooden
Fixed material
Linoleum
Metal
Tarmac
Gravel
Other
Not known
Underfoot Surface Condition
Even
Uneven
Normal Activity
Yes
No
Authorised to be there
Yes
No
Type of Duty
Ordinary
Overtime
Emergency call out
Other
Level of Supervision
Working under direct supervision
Working with others supervised
Working with others unsupervised
Working alone