Safety Reporting

    VOLUNTARY HAZARD REPORT FORM

    YOUR DETAILS: (तपाईंको विवरणः)
    FULL NAME: (पूरा नामः)
    DEPARTMENT:(विभागः)
    DESIGNATION: (पदः)
    CONTACT NUMBER: (सम्पर्क नम्बरः)
    FEEDBACK EXPECTED*: (सूरक्षा सूचनाको जवाफ)
    CONFIDENTIAL*: (यो सूचनाः)
    Hazard Information: (सूरक्षा खतराजन्य कुराको सूचनाः)
    Date: (मितिः)
    Time: (समयः)
    Place: (स्थानः)
    Details of Hazard: (सूरक्षा खतराजन्य कुराको विवरणः)
    Use extra sheet if required (यदि चाहिएमा थप कागज प्रयोग गर्नुहोस्)
    According to your view, will the hazard occur again? (Please tick) (तपाईंको विचारमा यो खतराजन्य कुरा फेरि हुन सक्छ)
    What may result from this hazard? (यो खतराजन्य कुराबाट के हुन सक्छ)
    What comments do you have about this hazard? (यो खतराजन्य कुरा सम्बन्धमा तपाईंको धारणा के छ)

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