Professional Documents
Culture Documents
CONTROL SHEET
Contract No.
Project Title
RA Reference RA/Department/Contract No/000
RA Date
RA Revision No. 00
Severity
4-9 Before task commences
10-16 Before task commences Medium - M Moderate injury / Illness Moderate Incident 3 3 6 9 12 15
20-25 Acceptable Low - L Minor injury / Illness Minor Incident 4 4 8 12 16 20
>25 Very Low - VL Slight injury (No lost time). First Aid Case. Slight Incident 5 5 10 15 20 25
Working group Designation Certain or
Very Likely Likely May Happen Unlikely
Imminent
Fill in & enclosed herewith WI HSE 069
Approved by:
Verified by: Client
Project Manager: Name: ________________________ Signature: ______________ Date / /
________________________ Signature: ______________ Date / /
Consultant Approval:
Construction Manager/Site Agent:
Name: ________________________ Signature: ______________ Date / /
________________________ Signature: ______________ Date / /