EHS Incident Reporting
Malaysia
1) Name (Optional)
2) Employee ID (Optional)
3) Area
*
HQ (Klang Valley)
Northern (Penang, Perak, Kedah)
Southern (Johor, Melaka, Negeri Sembilan)
East Coast (Kelantan, Terengganu, Pahang)
East Malaysia (Sabah, Sarawak)
4) Department
*
New Equipment (NE)
Service (SVC)
Office Employee
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5) Incident type
*
Near miss
Accident
Safety Violation
Safety Dilemma
Unsafe Act
Unsafe Condition
6) Date incident happen
*
 -
Day
 -
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
7) Location incident happen
*
8) Describe what happen
*
9) In your opinion, why did the incident happen?
*
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Submit
10)Do you have any comments or suggestion for safety improvement?
*
11) Leave your phone number if you want us to contact you further on this reporting.
Should be Empty: