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5. Check doors for heat before opening. (Do not open door if hot !.)
6. Assist people with disabilities.
7. Keep roadways and walkways clear for emergency vehicles.
8. DO NOT RETURN until emergency personnel give the all clear signal. Silencing of the
alarm does not necessarily mean the building can be reoccupied.
EMERGENCY CONTACT NO :
1. Unit Keselamatan - 03-5544 3999 (Hotline)
03-5544 2157
03-5519 4444
03-5519 4622
3. Bomba/Polis/Ambulan
999
Dean,
FAKULTI KEJURUTERAAN KIMIA
5. Check doors for heat before opening. (Do not open door if hot !.)
6. Assist people with disabilities.
7. Keep roadways and walkways clear for emergency vehicles.
8. Account for all students when arrive at the assembly point
9. Inform emergency personnel/administrator immediately if student(s) is/are missing.
10. Stay with class.
11. DO NOT RETURN until emergency personnel give the all clear signal. Silencing of the
alarm does not necessarily mean the building can be reoccupied.
EMERGENCY CONTACT NO :
4. Unit Keselamatan - 03-5544 3999 (Hotline)
03-5544 2157
03-5519 4444
03-5519 462
6. Bomba/Polis/Ambulan
999
Dean,
FAKULTI KEJURUTERAAN KIMIA
SH.UiTM.FKK (P.09).AIIR
FACULTY OF CHEMICAL
ENGINEERING
UNIVERSITI TEKNOLOGI MARA
Report
Please write legibly and send form to Faculty of Chemical Eng. Safety & Health Subcommittee (SOSHCo)
Use one form per accident / incident.
To be filled by Lecturer/Supervisor and Lab. Manager.
All accidents / incidents to be reported within 24 hours.
Fatal / Serious accident must be reported immediately to the Dean
Do not dispose evidences related to accident / incident.
First Aid
Date:
Damage only
Time
(24-hour clock)
Near miss/unsafe
Staff
Contractor
Visitor
Staff/Student Number
Hours worked on day of incident
UG Student
PG StudentVisiting Student
Position:
From:
To:
(24-hour clock)
OSH.UiTM.FKK (P.09).AIIR
Describe type and position of injury: (eg left leg bruised, cut to right index finger etc)
Type of injury
Agency of injury
Cut
Slip / Trip
Electrical
Exertion
Laceration
Strain
Scratch
Sprain
Laboratory
Equipment
Struck / Hit
Manual Handling
Knock
Sharp object
Bruise
Puncture
Amputation
Burn
Knife/blade
Door
Chemical
Hot object
Furniture
Glass
Slippery
Floor
Tools
Ladder / Stairs
Staff:
Position:
Contact no:
Name of witness
Staff/student no:
Position:
Contact no:
1st aider
Health Center
Hospital
GP
Self-treatment
None required
OSH.UiTM.FKK (P.09).AIIR
7. Inadequate ventilation
8. Inadequate supervision
Contact Number:
OSH.UiTM.FKK (P.09).AIIR
NADOPOD? Yes / No
Ankle
L/R
Foot
L/R
Lungs
L/R
Arm
L/R
Groin
L/R
Neck
L/R
Back
L/R
Hand / Wrist
L/R
Nose
L/R
Ear
L/R
Head
L/R
Rib / Chest
L/R
Eye
L/R
Heart
L/R
Shoulder
L/R
Face
L/R
Jaw
L/R
Toe
L/R
Finger
L/R
Leg
L/R
Other Specify
UNSAFE CONDITIONS
TRAINING
None exists or incomplete
Inadequate or not timely
Not understood or demonstrated
No refresher or not reinforced
Other - specify:
MANAGEMENT SYSTEM
OSH.UiTM.FKK (P.09).AIIR
No method available
Inadequate method
Misunderstood written
Misunderstood verbal
Not timely
Other - specify:
HUMAN FACTORS
Address of Doctor/Hospital:
Contact No:
Is this the first time this hazard or near miss has been reported?
Yes
No
Unsure
If this has been reported previously, when was it reported and to whom?
Signed:
Date completed