Park Derochie - I-Care
Friday, October 18, 2019
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I-Care Report

I-CARE Reporting Form

Enter your full name
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Enter the date the observation occurred
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I Wish to Report

An unplanned incident which had the potential for loss, but the outcome did not result in a loss.
An unplanned incident which had the potential for loss, but the outcome did not result in a loss.
An act which contravenes a known standard, creating a situation for potential loss.
An act which contravenes a known standard, creating a situation for potential loss.
A condition or situation identified as a HAZARD that if not corrected, has the potential to result in loss.
A condition or situation identified as a HAZARD that if not corrected, has the potential to result in loss.
An act where individual(s) were observed following a known standard, or a work condition observed to be compliant to a known standard.
An act where individual(s) were observed following a known standard, or a work condition observed to be compliant to a known standard.
Feedback, comment or suggestion which may improve the effectiveness or increase efficiency related to quality, health, safety or production.
Feedback, comment or suggestion which may improve the effectiveness or increase efficiency related to quality, health, safety or production.
Include as much specific information as possible e.g. WHO was observed, WHAT was observed, WHEN (time and or shift), WHERE (specific location), what equipment was involved, etc.
Was there potential for an individual to be injured
What corrective actions were taken, if any? Please describe
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