Field Safety Incident Reporting Portal
Name of person reporting incident
*
Franchise Name
*
State
*
Please Select
Andhra Pradesh
Arunachal Pradesh
Assam
Andaman and Nicobar Islands
Bihar
Chandigarh
Chhattisgarh
Delhi
Goa
Gujarat
Haryana
Himachal Pradesh
Jharkhand
Karnataka
Kerala
Ladakh
Lakshadweep
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Puducherry
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telangana
Tripura
Uttarakhand
Uttar Pradesh
West Bengal
Dadra and Nagar Haveli
Daman Diu
Jammu Kashmir
Region
*
Please Select
East
West
North
South 1
South 2
Customer Name
*
Sub Customer name
*
Name of the Activity
*
Please Select
Installation
Maintenance
Site Survey
Detail of Activity Customer Complaint Number or SO number
*
Date of Safety Event
*
Time of Safety Event
*
Location Details Address of the location
*
Type of Accident
*
Please Select
Road accident
At customer premises
Description of Safety Event
*
What caused it to happen
*
Date of Incident reporting
*
Time of Incident Reporting
*
Name of Investigator
Investigation Description
Type of Event
Please Select
Near Miss
Accident
Health and hygiene
Unsafe Situation
Unsafe Behavior
Impact Level
Please Select
Critical
Major
Minor
Route Cause Analysis
Corrective Action Taken to Close
Preventive Action Taken to resolve the issue permanently
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