Observation Report

OBSERVATION REPORT Form

SECTION 1 – THE ISSUE OBSERVED Raised By:

Raised When:

From What Branch:

Phone Number:

What Is The Issue? (Describe all available detail ):

What Have You Done/Do You Need Done About It?

SECTION 2 – QUICK ASSESSMENT – ACTION TAKEN/REQUIRED Passed To: Initial Receipt Accepted : Received When: This issue is a: Suggestion for an OFI Injury (See Injury Management) Customer Inquiry Possible Sale/Work Environmental/Quality Problem Quick Assessment – Action Taken/Required:

SECTION 3 – THE ISSUE RESOLVED Passed To:

Incident (See Incident Management) Complaint To Resolve Hazard/Risk To Assess/Manage Training Employee Skill Knowledge Other_____________________________.

Received When:

To close this issue, the following is to/has occurred:

This Issue Is: With CAT Team

The Action Plan Is Being Implemented

FRM-ALL-1026 -2 OBSERVATION REPORT

Closed Out Feedback Given

Issued: 19 July 2007 Page 1 of 2

OBSERVATION REPORT Form

SECTION 2 – QUICK ASSESSMENT – ACTION TAKEN/REQUIRED CONTINUED Quick Assessment – Action Taken/Required:

SECTION 3 – THE ISSUE RESOLVED (CONTINUED) To Close This Issue The Following Is To/Has Occurred:

FRM-ALL-1026 -2 OBSERVATION REPORT

Issued: 19 July 2007 Page 2 of 2

OBSERVATION REPORT Form

Overview. All issues/incidents reported using th ree step Observation Report :

•

Step 1 – Identify issue & report to nearest responsible person ,

• •

Step 2 –Develop solution & raise the necessary reports or escalate the issue , Step 3 – Responsible person & Branch Management fix the problem & record actions taken. Observation reports are triple carbonised with three sections :

Identifying & Reporting. All personnel , including management , are to have & use an Observation Report which is used to report all issues including : hazards , near misses, incidents , or injuries , equipment /plant deficiencies , customer complaints , concerns , complaint or dissatisfaction , to record management site visits , customer quality concerns /opportunities , feedback from staff to an employee on performance , breaches of procedure , poor performance , non -compliance , ideas as Opportunities for Improvement any other event of concern or abnormality . Person observing issue , completes Section 1 of the Observation report . WHITE COPY Passed to Responsible Person, YELLOW COPY Passed to CAT Team, GREEN COPY Kept by Observer NOTE: If the person making the observation can fix the problem they should do so .

Develop a Solution. Responsible person receives Observation Report and they :

• •

Initial the triplicate form as a proof of receipt & retain the White copy

•

If the issue requires more information ie injury etc then the responsible person collects the information & reports this in the relevant form ,

•

If the issue is not resolved provide guidance & escalate the issue further ,

•

Pass the Observation Report to the Branch Management

Assess situation & resolve if possible recording the action taken on Section 2,

Fix Issue Record Action Taken.

Responsible person develops solution

complete Section 2 detailing action taken & pass to Branch Management who :

•

Record the action on the CAT Actions Register

•

Raise the Observation Report with the CAT Team

• •

Sign-off the Observation Report as complete in Section 3 & provide feedback .

•

If incident involves insurance claim then appropriate processes to be followed .

If issue involves injury then Incident report raised immediately Management & Return to Work proce ss followed

& the Injury

OBSERVATION REPORT Form

START:

Issue Identified/Event Occurs

Observer Does What They Can To Assist Resolve Issue. Stop Work If Necessary Until Issue Resolved . Start Observation Report – Section 1 Pass To Responsible Person

Responsible Person Initials & Takes White Copy. Conduct Quick Assessment .

Issue Resolved Onsite ?

No

Is Risk Acceptable ?

No

STOP Work Escalate Issue Until Risk Controlled

Yes Yes

Escalate Issue For Resolution.

Record Results of Quick Assessment In Section 2 The Responsible Person may need after the Quick Assessment to raise further reports and paperwork such as: Incident Report & Investigation, Motor Vehicle Accident Report in Navision etc . If necessary the original Observer of the issue may need to be taken back to the Branch/Doctor etc to complete the process. Issue Passed To Branch Management to Either Resolve or Review & Confirm Action Taken By Responsible Person

Is Action So Far Acceptable. Can Issue Be Closed?

No

Provide Immediate Direction To Manage Issue. Refer To CAT Team, Develop Solution or Escalate To Corporate Assurance.

Yes

Close Out Issue

END:

Enter to Branch Actions Register

Complete Section 3 of Observation Report

Document History Versi on No.

Reason for change

1 2

Previous Document No

Authorised by

Date

New Document

D. Arundale

1 May 2007

Add Reference Only

D. Arundale

19 July 2007