STOP CARD
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General Safety Reporting
Enter Your Full Name
*
E-Mail Address
*
To be used for followup Notifications
Name of Station, Transporter, or Contractor Company you work with
*
Truck Driver
Transporter Staff
Contractor
Dealer
Station Manager
Station Supervisor
Pump Attendant
Shop Staff
Other Station Staff
Deviation
Near miss
Incident
Accident
Security Risk
Anomaly
Risk
Food Hygiene
Bad Driving
Date of Incident
*
Location of Incident
*
Briefly describe the incident
*
Probable Cause
*
Risk
*
Action proposed or taken
*
Attach Photo if any
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Clear
Submit
STOP CARD Report
Enter Your Full Name
*
E-Mail Address
*
Name of Station, Transporter, or Contractor Company
*
Dealer
Station Manager
Station Supervisor
Pump Attendant
Shop Staff
Other Station Staff
Driver
Contractor
Date of Incident
*
Where
*
Briefly describe the incident
*
Reason for STOP CARD deployment
*
Was this reason explained to the other party?
*
Yes
No
Was the other party aware of the meaning of this STOP CARD?
*
Yes
No
Was the hazardous operation stopped after the Deployment?
*
Yes
No
Were immediate corrective measures taken to mitigate the hazard?
*
Yes
No
If you selected Yes above, what measures were taken to mitigate the hazard.
*
Attach Photo if any
0%
Clear
Submit
