Name (Optional)
Job Number (Optional)
Date Of Close Call
Location
ELR
Structure No
Describe The Event
What could have happened?
What were you able to do about it?
Category
Mobile Plant
Manual Handling
Housekeeping
Struck By An Object
Physical Violence
Vehicles (Public)
Slip Or Trip
Hand Tools
Contact With Electricity
Fall From Height
Vehicles (Site) Including TM
Contact With Machinery
Falling/Flying Object
Heat/Spark/Fire/Flame
Environment
Equipment/Materials
Contact With Harmful Substances
Powered Tools/Plant
Dust Contamination
Access/Egress
Lifting Operations
Did this occur trackside?
Yes
No
Has there been a breach of the Life saving Rules (LSR)?
Yes
No
Please upload images of the close call
Send