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INDIA I-PJT RE-COMP

NEAR MISS INCIDENT /ACCIDENT DANGEROUS OCCURRENCE SUGGESTED PROFORMA
(To be submitted within 24 hours)

* Near Miss : Pipe Fell down during Erection

* Dangerous Occurrence: Damage to Material but not resulting in personal injury / illness during Erection.

Report No.: HSE/NMR/004

Name of Site: India I-PJT Re-Comp Date: 6/19/2022

Name of Work: Pipe Erection Contractor: Samho

Incident reported by : Mr.Hemant Kumar (Samho-Safety Representative)

Date & Time of Incident :19/06/2022 @ 9:20 Hrs

Location : Recomp Roof Area(Pipe Rack)

Eye Witness : Dilip Pandey (Samho- Site Engineer)

Brief description of incident: During erection of Pipe(Dia: 300mm, Weight:200 Kg,Height: 3 M) by forklift, suddenly pipe
slip from forklift due to loose the grip and broken the both rope(16mm dia,8mm dia).Pipe-1 hitted another pipe-2 and due to
high impact both pipes are fell down.

Pipe -1

Pipe -2

Probable Root cause of incident:

*Pipe not tied with strong rope
*Poor Management, not checked properly before start the lifting activity and not followed lifting rules.
Suggestion/corrective action: Samho immediately stopped the activity and informed to Mr.B Rama Moorthy area
incharge(Samho). SAMHO will be arrange special training for safety awareness.

Steps taken to avoid recurrence Yes X No

Site Safety Officer / Manager SECL HSE MANAGER

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NEAR MISS INCIDENT /ACCIDENT DANGEROUS OCCURRENCE SUGGESTED PROFORMA

(Signature and Name) (Signature and Name)
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INDIA I-PJT RE-COMP

NGEROUS OCCURRENCE SUGGESTED PROFORMA
e submitted within 24 hours)

not resulting in personal injury / illness during Erection.

Report No.: HSE/NMR/004

pe(Dia: 300mm, Weight:200 Kg,Height: 3 M) by forklift, suddenly pipe

both rope(16mm dia,8mm dia).Pipe-1 hitted another pipe-2 and due to

rt the lifting activity and not followed lifting rules.

stopped the activity and informed to Mr.B Rama Moorthy area
aining for safety awareness.
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NGEROUS OCCURRENCE SUGGESTED PROFORMA