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  • AFC-HSE-F05 - RTA or Damage Report

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    Ibrahim Mohamed
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    This damage and incident report form collects information about a damage incident including the name of the service authority and project details, location and time of incident, equipment and people involved, description of the damage and how it occurred, any authorities notified, actions taken, and remarks. Signatures are required from the person in charge and project manager to confirm the report. Attachments of additional documentation are also requested.

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    AFC-HSE-F05- RTA or Damage Report

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    This damage and incident report form collects information about a damage incident including the name of the service authority and project details, location and time of incident, equipment and people involved, description of the damage and how it occurred, any authorities notified, actions taken, and remarks. Signatures are required from the person in charge and project manager to confirm the report. Attachments of additional documentation are also requested.

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    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    6 views2 pages

    AFC-HSE-F05 - RTA or Damage Report

    Uploaded by

    Ibrahim Mohamed
    This damage and incident report form collects information about a damage incident including the name of the service authority and project details, location and time of incident, equipment and people involved, description of the damage and how it occurred, any authorities notified, actions taken, and remarks. Signatures are required from the person in charge and project manager to confirm the report. Attachments of additional documentation are also requested.

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    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 2

    DAMAGE & RTA REPORT

    1. Name of Service Authority:


    2. Project (Contract No):
    3. Location:
    4. Date & Time: Date: Time:
    5. Machine / Vehicle Involved: Plant No. Registration No
    6. Operator/Driver Details: Name: ID No.
    7. Name of Supervisor:
    8. Nature of Damage:

    9. How Damage Occurred:

    10. Have you informed the authorities: YES NO If Yes which?


    11. Action Taken:

    12. Remarks:

    NB: Attach any other reports, notifications, pictures, or statements from those involved.

    Person in Charge / Driver Name: Sig: Date

    Project / Construction Manager Name: Sig: Date

    HSE Dept. to ensure that report is sent to loss adjustor and/or insurance. Sign:
    Distribution: PM / CM / QS / Admin / Plant / Accts / HSEM / CPE. * delete if not appropriate

    Document No AFC-HSE-F05 Rev 00


    Revision Date 01-06-2017
    Cc: Project HSE file

    Document No AFC-HSE-F05 Rev 00


    Revision Date 01-06-2017

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