DOCUMENT NUMBER: 805
ISSUE DATE: SEPTEMBER 1996

REVISION DATE: DECEMBER 1998
SUBJECT: Unsafe Conditions Reporting Procedure

OBJECTIVE: To identify potentially unsafe conditions.

SCOPE: Applies to University of Alaska Fairbanks employees.

I. INTRODUCTION

The Unsafe Conditions Report has been developed to:

A. Provide a record of unsafe situations which occur in the workplace.

B. Serve as a focal point for taking action to prevent a possible loss.

C. Allow individual employees, who are directly affected by potentially unsafe conditions, to make recommendations for appropriate corrective action.

Instructions for completing the Unsafe Conditions Report are as follows:

A. Print your full name.

B. Enter the date that the situation took place.

C. Identify the name of the department in which you work.

D. Specify a phone number where you can be reached during work hours.

E. Describe the specific incident that initiated this report in sufficient detail to allow someone who was not present, or familiar with the operation, to understand what happened. For example:

a. If it involved a facility, or building, describe its location relative to other facilities, or landmarks. Please give an exact definition of the location as possible. Give the name of the building, the room number, and the specific area within the room.

b. If it involved a piece of equipment, list the name, size, horsepower, model number, and any other information available. 

F. Explain why the situation occurred or, in other words, what precipitated this incident. For example, if you have identified an icy condition as a potentially unsafe condition, was it the result of a poor building design which allowed ice to accumulate, or someone sweeping away the gravel which was put down to combat winter conditions.

G. Describe the potential for property loss, and/or injury, represented by the unsafe condition. This information is essential for preventing such losses so use your best judgment to identify potential damage, or injury, whether or not they actually happened on this occasion.

H. Describe what you, or others, did immediately after you noticed the potentially unsafe condition. For example, explain that you threw sand from an available container onto the icy area at the building entrance and then called the Physical Plant to report the problem. If you observed a frayed cord on an electric drill, you could respond by removing the drill from service and requesting that it be repaired.

I. List your recommendations for preventing this kind of situation in the future. Your direct observation puts you in the best position for reporting the problem. Recommendations from first hand observers are invaluable in resolving safety problems.

J. Provide a copy of the Unsafe Condition Report to your supervisor and the UAF Environmental Health, Safety, and Risk Management (EHS&RM) Department, box 8145.

WHY DID IT OCCUR? 

WHAT DAMAGE, OR INJURY, COULD OCCUR?

WHAT DID YOU DO IMMEDIATELY TO PREVENT THE DAMAGE, OR INJURY?

WHAT ARE YOUR RECOMMENDATIONS FOR PREVENTING THIS KIND OF SITUATION IN THE FUTURE?

cc: EHS&RM, Departmental Supervisor Copy, Individual Filing.

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