HEALTH, SAFETY AND ENVIRONMENTAL PLAN

ACCIDENT/INCIDENT REPORT
Details of Person Making This Report:

Name : JAMES NEEL Position: SAFETY OFFICER

Contact No: 0581161933

Date & Time of Report: 26/05/2020 Signature: JAMES NEEL

Accident/ Incident Details:

Silver Line
Project / Location &
Construction & Date of Event 25/05/2020
Plot no:
Machinery Rentals /
5337865
Date Reported Reported By KUMAR
26/05/2020
Event Type:-
Type of Treatment:-
Fatality / Major / 3 Day /
Minor or 1st aid /Major/
st
(1 aid / Doctor / Hospital) Dangerous Occurrence / PROPERTY DAMAGE
Vehicle Accident / Near
Miss) / Property Damage &
Environmental
Disturbance(Strong wind)
wind)
IP Name & ID no - __
IP (Injured Party)
Details Date of Joining & Position - __

Age and Sex - __

Event Details (What Happened)

Due to strong wind that hit our project site on 25-05-2020, boundary sheet of 30 running
meters has been damaged.

Action Taken (immediate & to prevent reoccurrence)

- Area has been immediately barricaded, where the fencing has been damaged.

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 HEALTH, SAFETY AND ENVIRONMENTAL PLAN
ACCIDENT/INCIDENT REPORT
Immediate Cause (Classification Codes)

A Treading on nails etc E Collapse of excavation I Trapped by machinery M Burns or scalds Q Welding flash

B Falls from height F Falling objects J Use of hand tools N Strains or sprains R Road accident

C Falls into excavation G Striking fixed object K Handling materials O Electric shock S Horse play suspected

D Falls on level ground H Struck by moving plant L Foreign bodies in eye P Heat exhaustion T Other unclassified

Root Cause

Unforeseen Act /
Unsafe Act Lack of Information Lack of Competence Environmental
Disturbance
Others
Management system
Unsafe Condition Lack of Training Poor Supervison
failure

Disabling Injury N Lost time N

Witnesses to the Accident / Incident

Name Position Company Contact No.

Kumar Site Engineer LBC 0564225178

Muthu kumar Project Engineer LBC 0555671884

Report Distribution:

Project Manager: HSE Engineer Others

Operation Manager General Manager Personal Depart.

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