UC Safety Alert Report

PHYSICAL / STRUCTURAL

Unstable scaffolding / ladder

Slippery / uneven floor surfaces

Protruding nails or sharp edges

Inadequate lighting on site

Blocked emergency exit routes

Unsecured heavy furniture / fixtures

ELECTRICAL & FIRE

Exposed wiring / live cables

Overloaded power sockets

Missing fire extinguisher

Blocked fire assembly point

Flammable material near heat source

Faulty electrical equipment in use

CHEMICAL / MATERIAL

Improper chemical storage

No SDS available

Unlabelled containers / materials

Chemical spill unattended

Waste not segregated properly

Dust / fumes uncontrolled

ERGONOMIC / ENVIRONMENTAL

Poor ventilation / extreme temperature

Excessive noise levels

Inadequate sanitation / welfare

Poor workspace arrangement

Cluttered workstation / walkway

Other (specify in Section 3)

Describe the condition observed in detail (include exact location, dimensions, duration)

Who could be harmed and how?

	Likelihood (1-5)	Severity (1-5)	Risk Score (L × S)	Rating
BEFORE CONTROL				Low Med High
AFTER CONTROL				Low Med High

Control Level	Control Measure Applied / Proposed	Applicable?
1 – Elimination	Remove the hazard entirely from the workplace	Yes No N/A
2 – Substitution	Replace with less hazardous material or process	Yes No N/A
3 – Engineering	Physical controls: guards, barriers, ventilation	Yes No N/A
4 – Administrative	Signage, SOP, training, work rotation, permits	Yes No N/A
5 – PPE	Gloves, goggles, hard hat, safety shoes, masks	Yes No N/A

#	Corrective Action	Responsible	Due Date	Status

BEFORE (Photo / Sketch)

[ Attach photo or sketch ]

Comments:

DURING RECTIFICATION

[ Attach photo or sketch ]

Comments:

AFTER (Condition Resolved)

[ Attach photo or sketch ]

Comments:

IDENTIFIED BY	VERIFIED BY (SUPERVISOR)	CLOSED BY (HSE / MANAGER)
Name: Sign: Date:	Name: Sign: Date:	Name: Sign: Date: