Scribd
Upload
957 views1 page

Neas Miss Report (Blank Format)

This near miss report describes an incident where a delivery truck got stuck after the driver took a U-turn on an excavated road. Luckily, no one was injured. The analysis determined the driver did not use the designated access road. Corrective actions included stopping work, assessing site conditions to safely reposition the truck, conducting a safety meeting, and advising all drivers to use designated turning points going forward.

Uploaded by

kkalvi
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
957 views1 page

Neas Miss Report (Blank Format)

This near miss report describes an incident where a delivery truck got stuck after the driver took a U-turn on an excavated road. Luckily, no one was injured. The analysis determined the driver did not use the designated access road. Corrective actions included stopping work, assessing site conditions to safely reposition the truck, conducting a safety meeting, and advising all drivers to use designated turning points going forward.

Uploaded by

kkalvi
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
You are on page 1/ 1

GI 6.

004, Supplement 1 - Near Miss Report Form

INCIDENT DETAILS

Date: 15/02/11 Time: 14 : 10 pm Location / Plant / Equipment MNJ.1 STA. 64 + 406 KM


Dept: Org. Code Division / Unit
Near Miss Description (Explain what happened - use attachments if needed)

The stringing group assisted the delivery truck at MNJ.1 Sta. 64 + 406 KM. After the unloading of pipes the
trailer driver was taking U Turn, the rare tire went through the edge of excavation caused the truck to stuck
and tilted. Nobody was injured in this incident.

ESTIMATE OF LOSS POTENTIAL (What injuries or losses might have occurred.)

Injuries: NONE

Property/Equipment Damage: NONE

Environmental Damage: NONE

Other: NONE

ANALYSIS (Why did it happen (List unsafe acts, unsafe conditions, wrong procedures/equipment, or other factors.)

The driver did not use the proper access road for taking U Turn in which the civil group constructed.

CORRECTIVE ACTION (What must be done to prevent recurrence - list recommendations)


1. Stop the work immediately
2. Assess the site conditions for taking trailer back to the proper position by using the wheel loader.
3. Toolbox meeting conducted with all drivers and the crew.
4. Advised all drivers to use the turning point.

REVIEWER INFORMATION
Reviewed By Supvr. or above (Name/Title/Badge): Date:02/15/11

Khurram Khalid Alvi Safety Manager / 426

Distribution: Original - Department files 1 copy - Facility Division Head 1 copy Area Loss Prevention Division (for serious near misses only

You might also like