Issued by: DMR Approved by: COO SQE/Form-G-005C

17-Oct-17
Iss/Rev:00/01
PT. VEKTOR MARITIM Ship File Office File Page 1 of 2
M-5

NEAR MISS & UNSAFE ACT / CONDITION REPORT

Vessel Name SUCCESS DALIA Report No. NMR/22/SD48/016
Position SINGAPORE Report Type Near Miss
Event Date 27-Jun-22 Possible Consequence COVID-19

1. EVENT DESCRIPTION
During Cargo Operation at Singapore found Surveyor no use life jacket and surgical face mask.

2. LESSONS LEARNT ( FOR NEAR MISSES ONLY ):To be filled in after discussion in Safety Committee Meeting.
Root Causes :
1. Person fall in to the sea and No Standard COVID-19
2. Lost of lives.
3. Lost of Time.
Corrective action :
1. Safety officer direct Inform to Surveyor to wear life jacket and give masker,Hand sanitaser.
2. Dirrect taken action to rejected Surveyor come on board.
3. close of safety meeting reminder to Surveyor to wear life jacket and masker for the future.
Preventive action :
Inform to duty officer and crews on duty to continued monitor,checked and Carried out patrol periodly by team duty ,-
during cargo operation,specialy for safety.

Lessons Learnt : Always awear Protective health equipments in port with Standard COVID-19.

3. All Near Misses and unsafe act /conditions are to be reported in this prescribed format and should be discussed in ship’s safety
committee meeting as soon as possible to determine onboard safety themes, corrective & preventive actions, education/training to
prevent recurrence and lessons learnt. This shall be reported in Section '2' of the form. This form must be forwarded to the Company
Office.

Note: Format for numbering system: NMR/ YY/XXX/ NNN (YY- last 2 digit of the year, XXX- ship’s 3 letter code, NNN- consecutive
No. of the Report). ( E.g.- NMR/09/HTY/001, means first Near Miss report in 2009 on the respective vessel)Some cells contain
comments (identified by small red triangle). Kindly fill this form electronically to see these Explanatory notes.
 Immediate Causes
Adverse weather and / or sea condition

Environmental condition

d monitor,checked and Carried out patrol periodly by team duty ,-