G@ ‘pipeals Aalto qed LL ol AMLARK ENERGY RESOURCES LLC Near-Miss/ Potential Incident Report is @ potential hazard or incident in which no property was damaged and no personal injury was sustained, but where, given a slight shift in time or position, damage or injury easily could have occurred, Near misses also may be referred to as close calls, near accidents, or injury-free events. For the sake of a safe work environment, the ‘company asksthat all employees report and correct any of these potential hazards immediately. Please use this form to report near-misses and assist us in preventing future incidents andmaking the Company a safer workplace Location: Rustag 09 lol [aera Witnesses (Optional enw Coren Type of Near-Miss: Type of Concern: 0 Near-Miss ronsafe act ‘@Safety Concern D Unsafe Condition of Area D Safety Idea/Suggestion 1 Unsafe Condition of Equipment 1D Unsafe use of equipment D Safety Policy Violation 1D Other- Describe: DF Other- Describe: Describe the potential incident/hazard/concern and possible outcome (be detailed): Employee wah mnaicivg Some odljustments under the Susreniel leek chile it fs menes Suddenly 1 ASKEL the Emeuyee ty move Away Crom Hne Position Were safety procedures violated? (describe): Yes. Wonuiny Under Bus porclal load Incident site inspection — Why was an unsafe act committed, or why was the unsafe condition present? Me was trylns tp ale Bone adlivitment ty Keer the lead Trorenly onthe leer Ie smnt Weve clone betore and te be Tedd tw Tecieve the Lom: Recommendations/steps to take to prevent a similar incident: Fy\wony mauanuve Mae Plt oY avn TS ready ty Tecieve the lee: De mersure the Size and mane Pion asrer that Name: Fogmon i Date Reported: 05 [01/2022 Signature: 2—T Reported to: muvemmeo Foner CUSED 6 fotlrer2.