Staff Details

Name: [PNL_1_Nissan_Employee]
Salary Number: [PNL_2_Nissan_Employee/Skype]
Email Address: [PNL_2_Nissan_Employee/Email]
Phone number: [PNL_2_Nissan_Employee/Employee telephone]
Supervisor: [PNL_1_Nissan_Supervisor]

Nature of Concern
Date of occurrence: [PNL_3_Date of Occurence]

Shop: [PNL_1_ER_Shop]
SEG Secretary: [PNL_1_ER_SEG Secretary]
Area: [PNL_3_ER_Area]
Facility: [PNL_3_ER_Facility]

Type of concern: [PNL_3_ER_Type of Concern]

Cause of incident: [PNL_3_ER_Cause of Incident]

Details:
[PNL_3_ER_Details of
Occurence]

Actions Taken
Details:
[PNL_3_ER_Details
Actions Taken]

Type of Concern
Type of Concern: [PNL_3_ER_Type of Concern]
[RC_INI_1_]
Did any substance enter the drains?: Yes
Details:
[PNL_3_ER_Details Type of Concern 1]

[RC_FIN_1_]
[RC_INI_2_]
Was any substance spilled onto the land?: Yes
Details:
[PNL_3_ER_Details Type of Concern 2]

[RC_FIN_2_]
[RC_INI_3_]
Was any waste produced?: Yes
Details:
[PNL_3_ER_Details Type of Concern 3]
NISSAN MOTOR MANUFACTURING (UK) LIMITADED
Enviromental Concern Report

[RC_FIN_3_]
[RC_INI_4_]
Has a substance been released?: Yes
Details:
[PNL_3_ER_Details Type of Concern 4]
[RC_FIN_4_]
[RC_INI_5_]
None of the above?: Yes
Details:
[PNL_3_ER_Details Type of Concern 5]
[RC_FIN_5_]

Contact with Regulator

Reported to regulator?: [PNL_3_ER_Reported to Regulator]
Regulator name: [PNL_2_ER_Regulator Name/Full Legal Requirement: [PNL_3_ER_Legal Requirement]
name]
Comments:
[PNL_3_ER_Contact with regulator Comments]

Target date and root cause

Target date: [PNL_3_Target Date]
Technical cause analysis:
[PNL_3_ER_Technical Why 1]
[PNL_3_ER_Technical Why 2]
[PNL_3_ER_Technical Why 3]
[PNL_3_ER_Technical Why 4]
Management cause analysis:
[PNL_3_ER_Management Why 1]
[PNL_3_ER_Management Why 2]
[PNL_3_ER_Management Why 3]
[PNL_3_ER_Management Why 4]
Action taken for future prevention:
[PNL_3_ER_Action taken for future prevention]

Prevention actions completed? [PNL_3_ER_Prevention actions completed?]

Assigned Responsibility
Department: [PNL_3_ER_Department]
Additional Circulation List: [PNL_3_Additional circulation]
Comments:
[PNL_3_ER_Assigned responsability comments]
NISSAN MOTOR
MANUFACTURING (UK)
LIMITADED
EnviromentalRecords
ConcernofReport
every rejection and reason
[HIST_Rejection comment record]