HEALTH, SAFETY AND ENVIRONMENTAL PLAN

INCIDENT/ACCIDENT REPORT
Details of Person Making This Report: Insident#EP05082019

Name : Manu Eldose Position: Safety Officer

Contact No: 0561884467

Date & Time of Report: 05/08/19 09:45am Signature: Manu Eldose

Accident/ Incident Details:

05/08/19
Project / Location &
Date of Event
Plot no: Eco pack
Velraj
Date Reported Reported By
05/08/19
Hospital Event Type:- Minor
Type of Treatment:-
Fatality / Major / 3 Day /
Minor or 1st aid /Major/
(1st aid / Doctor / Hospital) Dangerous Occurrence /
Vehicle Accident / Near
Miss) / Property Damage &
Environmental Disturbance

IP Name & ID no - Dayadhar Mishra

IP (Injured Party)
Details Date of Joining & Position -

Age and Sex -

Event Details (What Happened)

While pulling the armour cable, the nylon rope snapped and swung violently. Unfortunately
one of our electrician who was signaling the vehicles nearby got hit by the nylon rope on his
face. The rope hit the face of the employee in between the cheek bone and eyes causing
bleeding, inflammation and hairline fracture on his nose.

Action Taken (immediate & to prevent reoccurrence)

First aid was given immediately and the employee was taken to hospital. The Doctor
diagnosed the patient and referred to an ENT specialist for for further treatment.

Immediate Cause (Classification Codes)

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 HEALTH, SAFETY AND ENVIRONMENTAL PLAN
INCIDENT/ACCIDENT REPORT
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
Behavioural Factor
Othrs
Management system
Unsafe Condition Lack of Training Poor Supervison
failure

Disabling Injury N Lost time 2(Days)

Witnesses to the Accident / Incident

Name Position Company Contact No.

Fayad Electrical Engineer LBC 0551342218

Arockiyasamy Plumbing Foreman LBC 0565065138

Report Distribution:

Project Manager: HSE Engineer Others

Operation Manager General Manager Personal Depart.

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