eForm 17 - Non-Conformance Report - Short-form

This form should be used to record Non-conformance, corrective, preventative, improvement actions, complaints, customer or stakeholder views, incident, near miss report, accident (Any accidents should also be recorded in the accident book, if you think this could be a RIDDOR contact your Safety Advisor immediately).


NOTE: This form will add the initial entry to the eForm17 database. It will require to be reviewed and updated as further information becomes available, corrective actions are developed and when the entry finally closed out

Record the location of the event.

Select the appropriate Centura Company from this list

Select
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If this is a site report please add your Contract Number (FALxxxxxx, CHExxxxxx, etc.)

If the report is from a regional office this can be left blank.

Select your business unit from the following list

Select
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This date should be the date you complete this form, not the date of the incident

Type of event*

Please select the type of event being reported.

Select the nature of the event from the types shown below

Please ensure the correct date of the incident is entered here

Add the time when the incident occurred here. If this is not known please state this.

Severity Green (minor) Yellow (significant) Red (major)*

Identify the severity of the incident using the traffic light buttons below.

Provide full details of the incident / issue / complaint received (or just a summary if you are also attaching a separate report or document). Include information such as names of any third parties or others involved.

  • Immediate causes
  • Underlying or Root cause(s)

Immediate, emergency or short-term or actions to stop things getting worse, contain damage, or stop it happening again soon. Or your plans to do so.

What is the planned or actual date for completing these containment actions

Medium or long-term corrective actions, including RAMS reviews, training or TBTs, communication with client/subcontractor/neighbours.

Also note here if you need assistance identifying root causes or agreeing suitable action plans.

Drag any files into this field and they will be saved within the report. This can be any type of document or photograph that will act as supporting information for your report. If you are using a mobile device to create this report this will also attach photographs taken using the devices camera.

Drag and drop files here or
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