SmartCheck | COMPUTERISED MAINTENANCE MANAGEMENT SYSTEM

Raise Incident

Incident No :

Select Department^*

Select Asset^(Optional)

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General Information
Reported By^*
Report Date^* Contact Phone^*
Incident/Date & Time^* Incident Occurred Place ^*
Incident Effect
Occupational Health and Safety^*
Functional scope
Functional scope^*
Type of Incident Please see the guidance tab for the definitions
Type of Incident^*
Incident / Accident Categorization
Select Incident^* Select Type^*

	Service / Operations Related^*	Environmental Release^*	Health & Safety Related^*
Incident / Accident Categorization

Minor^*	Services operable but at a reduced level of performance with delays.	Negligible loss or damage/non-reportable environmental release/Informal investigation is required/Loss or damage does not affect operations.	Minor Injury or No impact on the Business
Major^*	Resulted in limited disruption/ moderate loss to business or damage affecting entire site	Environmental damage requiring an extensive clean-up resulting in extensive loss work time, Significant loss of high-value assets.	Major hospitalization case, serious injury or illness to either employees or key stake holders.100 % of the services are disrupted with restore time more than an hour. Hospitalization cases but resolved in less than 24 hrs. major injury case
Critical^*	Loss or damage permanently suspends routine operations throughout site and other sites/Major loss of market share/Major physical (proto-type unit or device) or intellectual (strategic plans) property loss or severely affecting key stake holders & occurs with warning more than 24 hrs.	Catastrophic loss or damage extending beyond site (point of origin)/Onsite facility/reportable environmental release affecting site and offsite facilities	Death of employees or key stake holder or permanent physical damage

	Person involved Information - Fill the details only if someone is injured
	SNO	Name	Job Title	Gender	Fatality	HCL Employee? Or Contractor / Visitor / Any other	Employee ID	Is the person injured? State the injury	Pre-medical conditions?	Man-Days lost estimated

Circumstances (What happened?) and consequences

Problem Description

Why 1

Why 2

Why 3

Why 4

Why 5

Root Cause Description resulting from the "5 Whys" analysis

Immedicate Correction

Corrective actions:

Lessons learnt & Preventive Actions


	SNO	Preventive Actions	Who	Deadline

Checkpoints		Yes/No	Remarks
Incident Closure Validation by Functional Manager/City Manager/QHSEE Managers as applicable
Whether the Immediate & corrective actions are effective?
Whether the preventive actions are effective?
Hierarchy of Control Action Taken:
1.Elimination
2. Substitution (use an alternative)
3. Isolate (separation from hazard)
4. Redesign (change equip/process)
5.Administration (change work practice)
6. Personal Protective Equipment(gloves, glasses, hearing protection)

Attachment1^(Optional)

Attachment2^(Optional)

Attachment3^(Optional)

Attachment4^(Optional)

Attachment5^(Optional)

Guidance

S.no.	Definitions
1	Injury and ill health : Adverse effect on the physical, mental or cognitive condition of a person These adverse effects include occupational disease, illness and death. The term injury and ill health implies the presence of injury or ill health, either on their own or in combination.
2	Incident: Occurrence arising out of, or in the course of, work that could or does result in injury and ill health. An incident where injury and ill health occurs is sometimes referred to as an accident. An incident where no injury and ill health occurs, but has the potential to do so, may be referred to as a near-miss, near-hit or close call. Although there can be one or more nonconformities related to an incident, an incident can also occur where there is no non conformity.
3	Corrective action: Action to eliminate the cause(s) of a nonconformity or an incident and to prevent recurrence.
4	First Aid Injury: First Aid Injury is an injury that requires a single first aid treatment and a follow-up visit for subsequent observation involving only minor injuries (Minor scratches, burns , cuts and so forth ) which do not ordinarily require medical care , and for which the person would typically immediately to their normal activities .
5	Loss Time Injury(LTI): A disabling occupational injury or illness that results in a person being unfit for work on any day beyond the day of the incident. Any day includes rest days, weekend days, leave days, public holidays or days after ceasing employment"
6	Man Days Lost : The day on which the injury occurred or the day the injured person returned to work are not to be included as man-days lost; but all intervening calendar days (including Sundays or, days off, or days of plant shut down) are to be included. It after resumption of work, the person injured is again disabled for any period arising out of the injury which caused his earlier disablement, the period of such subsequent disablement is also to be included in the man-days lost.
7	Environmental release: Any release (Oil or Chemical) which is a part of any routine or nonroutine operations and includes release from secondary containment such as spills or leaks into land or water. It also includes the discharge of effluent or air releases or soil contamination.
8	Reportable incident: All types of incidents falling under the category of Major and Critical as explained in the above table are reportable. Additionally, the accidents which are under legal obligations,such as Hazardous and Other Wastes (Management and Transboundary Movement) Rules, 2016 , need to be considered as critical reportable incidents.

Raise Incident

Incident No :

Select Department^*

Select Asset^(Optional)

Select Sub Asset^(Optional)

General Information
Reported By
Report Date		Contact Phone
Incident/Date & Time		Incident Occurred Place

Incident Effect
Occupational Health and Safety

Functional scope
Functional scope

Type of Incident Please see the guidance tab for the definitions
Type of Incident

	Service / Operations Related ^*	Environmental Release^*	Health & Safety Related ^*
Incident / Accident Categorization

Minor^*	Services operable but at a reduced level of performance with delays.	Negligible loss or damage/non-reportable environmental release/Informal investigation is required/Loss or damage does not affect operations.	Minor Injury or No impact on the Business
Major^*	Resulted in limited disruption/ moderate loss to business or damage affecting entire site	Environmental damage requiring an extensive clean-up resulting in extensive loss work time, Significant loss of high-value assets.	Major hospitalization case, serious injury or illness to either employees or key stake holders.100 % of the services are disrupted with restore time more than an hour. Hospitalization cases but resolved in less than 24 hrs. major injury case
Critical^*	Loss or damage permanently suspends routine operations throughout site and other sites/Major loss of market share/Major physical (proto-type unit or device) or intellectual (strategic plans) property loss or severely affecting key stake holders & occurs with warning more than 24 hrs.	Catastrophic loss or damage extending beyond site (point of origin)/Onsite facility/reportable environmental release affecting site and offsite facilities	Death of employees or key stake holder or permanent physical damage

	Person involved Information - Fill the details only if someone is injured
	SNO	Name	Job Title	Gender	Fatality	HCL Employee? Or Contractor / Visitor / Any other	Employee ID	Is the person injured? State the injury	Pre-medical conditions?	Man-Days lost estimated

Circumstances (What happened?) and consequences

Problem Description

Why 1

Why 2

Why 3

Why 4

Why 5

Root Cause Description resulting from the "5 Whys" analysis

Immedicate Correction

Corrective actions:

Lessons learnt & Preventive Actions


	SNO	Preventive Actions	Who	Deadline

Checkpoints		Yes/No	Remarks
Incident Closure Validation by Functional Manager/City Manager/QHSEE Managers as applicable
Whether the Immediate & corrective actions are effective?
Whether the preventive actions are effective?
Hierarchy of Control Action Taken:
1.Elimination
2. Substitution (use an alternative)
3. Isolate (separation from hazard)
4. Redesign (change equip/process)
5.Administration (change work practice)
6. Personal Protective Equipment(gloves, glasses, hearing protection)

Attachment1^*

Attachment2^*

Attachment3^*

Attachment4^*

Attachment5^*

	Company Name

	Name
	Email Id
	User ID / Mobile Number
	Address

	Location
	Pin Code

Notice

Incident Check

Incident / Accident Categorization
Select Incident		Select Type