8/20/2019 Laporan Kertas Kerja ES Modul 1

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TAJUK : MELAKSANAKAN KEMAHIRAN KESELAMATAN

 NO KUMPULAN:………………………………………………

 NAMA :1.……………………………………………………..

:2---------------------------------------------------------------

:3.--------------------------------------------------------------

:4---------------------------------------------------------------

PROGRAM : ……………………………………………………..

TARIKH : ……………………………………………………..

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8/20/2019 Laporan Kertas Kerja ES Modul 1

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8/20/2019 Laporan Kertas Kerja ES Modul 1

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SAFETY AND HAZARD REPORTING FORM

DATE: ___________________________ TIME OF DAY: __________________ 

LOCATION OF HAZARD:  _________________________________________________ EXISTING CONDITION CONSIDERED TOHAZARDOUS: _______________________________________________ 

 _________________________________________________________________  _________ 

 _________________________________________________________________  _________ 

HAS THIS BEEN REPORTED TOANYONE?

 ____________________________________________________________ 

 _________________________________________________________________  _________ 

OTHER COMMENTS: _________________________________________________________________ 

 ____________________________________  _________________________________________________________________ 

 ____________________________________ 

OPTIONAL

NAME: ___________________________________________

PHONENUMBER: ______________________ DEPARTMENT:

 ____________________________________________________________  __________________________ 

FOR USE BY DEPARTMENT OF PUBLIC SAFETY 

Inspect!n D"te: ___________________________#!$% O$&e$ S'()tte&: __________________________ 

E*stn+ C!n&t!n: ____________________________________________________________ 

 _________________________ A("te)ent D"te: ___________________________________

F!,,!-.'p /Y0N1: _______________________________ 

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 NO KUMPULAN KA7ASAN KAJIAN

1 ILIK GURU

2 KANTIN

3 UNIT LAN8SKAP

4 8E7AN MAKAN ASPURA

9 MAKMAL SAINS 1