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

1-Aug-12
Rev: 0
PT. VEKTOR MARITIM Ship File Office File Page 1 of 2
M-5

NEAR MISS & UNSAFE ACT / CONDITION REPORT

Vessel Name SC DALIA XLVIII Report No. NMR/22/SD48/012
Position AT BALIKPAPAN Report Type Unsafe Act / Condition
Event Date 4-Jun-22 Possible Consequence Personal Injury

1. EVENT DESCRIPTION
DURING MANEOVERING FOUND MAIN AIR COMPRESSOR No.3 WATER COOLING PIPE BROKEN

- Potential hazard :
1. Human Injury
2. Damage Equipment

2. LESSONS LEARNT ( FOR NEAR MISSES ONLY ):To be filled in after discussion in Safety Committee Meeting.

Root Causes : Due to does not follow the procedures/safety work on machieneries

Corrective action : Immediately stop compressor and start other compresso

Preventive action : Reminder Crews to carry out safety check when compressor running and ensure that safe working

Lessons Learnt : Safety inspection to implemented on board and ensure this item not repeat.

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.