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Safety Observation Report Form

This document outlines the Suraksha Yogdan (SIO) reporting form used by NACL Spec-Chem Limited, Dahej to report unsafe acts, conditions, and near misses. The form collects details of the observation including date, time, location, description, immediate actions taken, further required actions, comments and recommendations. It also tracks follow up actions by supervisors, EHS department, zone leaders, and execution departments. The goal is to document observations, ensure immediate safety, and implement actions to prevent reoccurrences.

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306 views2 pages

Safety Observation Report Form

This document outlines the Suraksha Yogdan (SIO) reporting form used by NACL Spec-Chem Limited, Dahej to report unsafe acts, conditions, and near misses. The form collects details of the observation including date, time, location, description, immediate actions taken, further required actions, comments and recommendations. It also tracks follow up actions by supervisors, EHS department, zone leaders, and execution departments. The goal is to document observations, ensure immediate safety, and implement actions to prevent reoccurrences.

Uploaded by

satya naga
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

NACL Spec-Chem Limited, Dahej

Integrated Management System Procedure


Document Type Format
Document No. Ver. No. /Rev. No. 00/00 Page 1
Department EHS & S Revision Date NA of 2
Title Suraksha Yogdan Reporting Form
SIO Reporting Date:
Observer Name GN E. Code / Contra. 70001 Observer Dept EHS & S
Satyanarayana Name
Plant Chlorine Shed Floor GF Location Outside
Observation Date 12-08-2023 Observation Time 8:30 Name of Sign of
reporter
SIO Type Unsafe Act Unsafe Condition Near Miss

Description of Observation

Immediate action taken by observer

Further actions required to avoid re-occurrence

Comments by immediate Supervisor / HOD of observer

Date :_______________ Name & Sign of Supervisor / HOD ___________________________________


----------------------------------------------------------------------
SIO Report receiving date: ___________ Name & Sign of Receiver (EHS dept) :_________________________
Category Sub-Category Opportunity

SIO Risk High Medium Low


Recommendation by EHS dept (If any)

Forwarding Date :_____ __________ Forwarded to :_________________ By :____________________

Actions / Remarks by Zone Leader

Intimated to Execution dept on ______________, Name and Sign of Zone Leader


NACL Spec-Chem Limited, Dahej
Integrated Management System Procedure
Document Type Format
Document No. Ver. No. /Rev. No. 00/00 Page 2
Department EHS & S Revision Date NA of 2
Title Suraksha Yogdan Reporting Form
-- -- -- --- - -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Action plan by execution department

Expected Date of Compliance __________________ Name & Sign of HOD of executer ____________________
SIO is completed on ___________________ and forwarded to EHS dept

Name and Sign of Executer Name & Sing of Reporter Name & Sign of Zone Leader
Completed SIO received on ______________ Name & Sign of receiver (EHS) _________________
Completed SIO reviewed on _______________________ Name & Sign of reviewer (EHS) __________________

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