Template

KGM Unsafe Act, Condition and Equipment Report

by Gerald Visagie, from the Community

Use this KGM safety checklist to report unsafe acts, unsafe conditions, and substandard or unsafe use of equipment on site. Capture date and time, location, department or company, people involved, detailed description, immediate corrective actions, and who the issue was reported to, including supervisor, foreman, superintendent, manager, safety, or control room. Designed for mining operations to improve hazard awareness and prevent incidents.

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Confirm accountability and compliance with a digital log

With SafetyCulture you can

Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

About author

Community

This community page makes available free workplace checklists and templates created by other users within the SafetyCulture community. SafetyCulture has re-published this content and where possible, has credited the original author. SafetyCulture has not verified the accuracy, reliability or suitability of any community content. You agree that your use of any of this content is in accordance with SafetyCulture’s Terms and Conditions.

Template
Near Miss Report Template
This Near Miss Report template helps construction teams quickly capture and investigate near-miss events before they cause harm. Record key details such as document number, client or site, date and time, location, personnel, and department. Identify factors including unsafe acts, unsafe conditions, unsafe equipment, or improper equipment use. Describe the incident or hazard, attach photos, and capture employee signatures and dates. The investigation section guides users to document the near-miss condition, identify primary and contributing causes, and define corrective actions such as removing hazards, replacing or repairing equipment, or retraining staff. Includes management sign-off to close the loop and improve site safety and HSE compliance.
by Chris Graydon, from the Community
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Template
Unsafe Action/Condition Notification
This unsafe action or condition notification template helps teams document breaches of health, safety, or environmental rules on site. Record worker and subcontractor details, induction number, activity, location, date and time observed, and whether the incident warrants a yellow or red card. Describe the unsafe act or condition, note previous offences, and specify corrective actions to prevent recurrence. Capture acknowledgements and signatures from the issuer, subcontractor, and management close-out, with optional comments and distribution to project and HSE stakeholders.
by Werner De Klerk, from the Community
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Template
Construction Disciplinary Write up Form
Use this disciplinary write up form to document onsite safety violations and corrective actions. Record the company and worker involved, incident location, date and time, warning type and count, and the specific safety issue such as unsafe acts, missing PPE, unsafe conditions, or failure to follow procedures. Capture related items like training cards, self inspections or JSAs, and intervention steps. Include notes and obtain required signatures from the safety officer and supervisor to formalize actions and support site compliance.
by Peter Affum, from the Community
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Template
Unsafe Machinery and Equipment Report Form
Use this unsafe machinery and equipment report form to document faults, serial numbers, machine details, location, and who was notified. Record remedial actions, note if the item is taken out of service, track in-house repairs or service engineer visits, and capture repair dates. Include manager or supervisor confirmation that the item is fit for use. For guidance only; seek professional advice for your workplace.
by SafetyCulture
Downloads: 0
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Near Miss Report Template

This Near Miss Report template helps construction teams quickly capture and investigate near-miss events before they cause harm. Record key details such as document number, client or site, date and time, location, personnel, and department. Identify factors including unsafe acts, unsafe conditions, unsafe equipment, or improper equipment use. Describe the incident or hazard, attach photos, and capture employee signatures and dates. The investigation section guides users to document the near-miss condition, identify primary and contributing causes, and define corrective actions such as removing hazards, replacing or repairing equipment, or retraining staff. Includes management sign-off to close the loop and improve site safety and HSE compliance.

by Chris Graydon, from the Community

Get

Template

Unsafe Action/Condition Notification

This unsafe action or condition notification template helps teams document breaches of health, safety, or environmental rules on site. Record worker and subcontractor details, induction number, activity, location, date and time observed, and whether the incident warrants a yellow or red card. Describe the unsafe act or condition, note previous offences, and specify corrective actions to prevent recurrence. Capture acknowledgements and signatures from the issuer, subcontractor, and management close-out, with optional comments and distribution to project and HSE stakeholders.

by Werner De Klerk, from the Community

Get

Template

Construction Disciplinary Write up Form

Use this disciplinary write up form to document onsite safety violations and corrective actions. Record the company and worker involved, incident location, date and time, warning type and count, and the specific safety issue such as unsafe acts, missing PPE, unsafe conditions, or failure to follow procedures. Capture related items like training cards, self inspections or JSAs, and intervention steps. Include notes and obtain required signatures from the safety officer and supervisor to formalize actions and support site compliance.

by Peter Affum, from the Community

Get

Template

Unsafe Machinery and Equipment Report Form

Use this unsafe machinery and equipment report form to document faults, serial numbers, machine details, location, and who was notified. Record remedial actions, note if the item is taken out of service, track in-house repairs or service engineer visits, and capture repair dates. Include manager or supervisor confirmation that the item is fit for use. For guidance only; seek professional advice for your workplace.

by SafetyCulture

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KGM Unsafe Act, Condition and Equipment Report

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You might also like

Near Miss Report Template

Unsafe Action/Condition Notification

Construction Disciplinary Write up Form

Unsafe Machinery and Equipment Report Form

You might also like

Near Miss Report Template

Unsafe Action/Condition Notification

Construction Disciplinary Write up Form

Unsafe Machinery and Equipment Report Form