Close Call Report Form Close Call Report Form This form is for reporting Close Calls - REMEMBER TO TAKE PHOTOGRAPHS IF YOU CAN - YOU WILL HAVE THE OPPORTUNITY TO UPLOAD THEM LATER In addition to reporting the call via this form you should report the Close Call to your supervisor and/or site manager as soon as safe and possible, you may stop someone from being injured. For every Close Call you report, Electrification Construction Services Ltd will donate to a Charity of your choice Company Division * OHL Construction Division Isolation Division Welding Division De Vegetation Division Plant / Transport Division Support Services What was the lighting condition at the time? (Choose) * Daylight Artificial Lighting (Site Lights) Dark (Personal Lighting Only) What Type of Close Call is this? * Plant Breakdown / Failure Safety Issue / Problem Positive Observation (i.e. Good Practice Observed) Weather Conditions at the time (Choose) * Wet Dry Icy / Snow List Plant & Equipment With Asset Numbers On what date did it happen? * Time * 000102030405060708091011121314151617181920212223 : 00153045 Who Were You Working For (ECS or Client) * Enter Location / Site * 1. Describe what you have seen - (Give as much detail as possible.)2. Describe what Could have happened - Could anyone have been injured?3. Describe anything that could have caused damage to the infrastructure * 1. Describe what were you able to do about it? 2. Describe what you did to make it safe? * You Indicated that this is a Positive report, Describe the good practice observed * Name Your Contact Phone Details (In case we need to discuss the Close Call with you). Email Address - Allows you to get a copy of your Close Call If you have taken any photo's of the Close Call, please upload them here. Drop a file here or click to upload Choose File Maximum upload size: 67.11MB Reporting of Close Calls/Good Calls is a key safety step in the prevention of incidents and accidents. All of us have a part to play in ensuring ourselves and others get home safe every day without injury and we encourage that you identify and raise close and good calls. ECS have decided that this year we would like to identify 3 to 5 charities of your choice and for every Close Call/Good Call we will donate £1 to our chosen charity. For a reminder A Close Call is defined as anything that has the potential to cause harm or damage. Charity 1 Charity 2 Electrification Construction Services Ltd thank you for taking the time to report this Close Call, your help in highlighting any Safety issues or Good practice, is very much appreciated. If you are human, leave this field blank. Submit
