Survey form Please fill in the following form for each individual incident/accident and the measures taken to prevent it in future Incident 1. Kind of incident: AccidentNear MissPotential Risk 2. When did the incident occur? 2000200120022003200420052006200720082009201020112012201320142015201620172018201920202021 Which machine? 3. Where did the incident happen? Please selectProduction machine (winder incl. unwinding and glueing)In-line cutter (or similar)Semi automatic packingPacking (handling) robotPalletiserOff-line cuttingOther off-line core treatment equipmentIn-line dryingOff-line dryingForklift road or transport accidentPaper reel handling accidentTruck loading / unloading (raw material or finished goods)Maintenance activitiesElectrical shockother 3a. Please fill in a short description (Type/Model/Age) Description of incident 4. Please fill in a short description of the incident Measures 5. Which improvements have been made in order to prevent this incident from occurring in future? Please fill in your measures. Photos 6. Please attach several photos of this incident You can upload up to 8 files (max. size 2 MB each)