PT GEMILANG BINA LINTAS TIRTA

SHIP MANAGEMENT

NEAR MISS REPORT (11.04.2016) Rev no. 01 S – 06

SHIP'S NAME : BULL PAPUA NEAR MISS REPORT NO.

A NEAR MISS is an unplanned event that did not result in injury or damage but had the potential to do so.
In short – ‘close call’ OR an accident that almost happened.

Please check all appropriate conditions:

v Unsafe Act v Unsafe Condition v Unsafe Equipment v Unsafe use of Equipment
TO: DESIGNATED PERSON
Section A (Description of event / potential hazard) Date : 8 July 2020

On 8 July 2020 during inspection at cargo pump room found stripping pump leaking.
Potential hazards:
1. Flooding in pump room.
2. Minor pollution.

Signature :

Signature :
Head of Dept: Deck / Engine Master / Engineer :

Section B
(1) Investigation of incident (primary and / or contributing causes)
. Found leaking from valve lock nut loosen
Corrective Action taken (remove hazard, replace, repair or re-train in proper procedures for
the task)
1. Open valve cover and retighten the nut

(2) Preventive Action (Action to prevent the same matter will not recurrent)
1. Routine properly inspection all space to make sure all machinery and system in good
order.

Date completed correction action: 8 July 2020

Signature :
Head of Dept: Deck / Engine Master Signature :

Section C ( Additional recommendation / Follow Up )

Corrective Action Completed Date : Signature

 PT GEMILANG BINA LINTAS TIRTA
SHIP MANAGEMENT

NEAR MISS REPORT (11.04.2016) Rev no. 01 S – 06

  Superintendent / DPA