Date & Time of Incident:21/09/2018,

Operating Unit / Site: GIPL

12.30pm Format No. EHS-CS/F/26-R0
EHS Incident Analysis Report
Regular Division / Department:MEP Name of injured Person: Hemant Body part affected: N/A
Bhelekar

Case / Issue Report prepared by : Date of birth: Location where treatment was provided:
Preliminary report [ y ] Date: 21/09/2018 Team: MEP
Number:1 Atul Shelke N/A
Final report [ ] Date: 21/09/2018 Shift: First
Male [ y ] Female [ ]
First Aid Case [ ] Environmental Incident [ ] Recordable Case [ ] Supervisor:Mr.Madhav Babulgavkar(GIPL) Designation: Engineer(Automation)
SOFTCON system
Near Miss [ Y ] Medical Treatment Case [ ] Lost Time Injury [ ]

Incident Description Sketch or Insert Photo

1) Describe the activity / task to be performed.

At the time of software installation time in IT room production block 2nd floor .(12.30pm)

2) List the sequence of events and identify the object or substance that is suspected of
directly harming the person.

Hemant going to production Block second floor IT room for software installation

Touches to right hand in another It rack (which is installed by the vendor of the GIPL)

He felt minor tingling sensation as he touched IT rack

He informed immediately to Mr. Madhav( is responsible for IT work)

No any personal injury

Description of the Injury, Near Miss, etc. Incident Location

Production block 2nd floor IT room
Near Miss

Name of Witness & Statements

Hemant, Madhav

How long has this person been performing this type of work?
Are written operating procedures / Risk Control Plan
From One Month YES [ y] NO [ ] Was this task identified in JSA or RCP ? YES [ y ] NO
developed for this task?

Subject of the last safety contact / talk:

Safety meeting-21/09/2018 Were written operating procedures / Risk Control Plan being
YES [ y ] NO [ ] Was the person wearing the required PPE? YES [y ] NO [ ]
followed?

Date: 21/09/2018 Given By: Atul Shelke

These procedures were reviewed with this person. YES [ y] NO [ ]

Containment - Describe Immediate and / or Interim Actions Who Date Status

Mr . Rajesh Verma 8/21/2018 closed

Body earthling connections were checked at IT panel and at UPS supply end
problem noticed action planned realization done

Most Probable Cause(s) Analysis: Insert the Incident Description from above and determine Most Probable Cause(s) using the Fishbone Diagram.
Circle the most likely causes.

Machine Methods / Tools Material

another agency IT rack

leakage current from compotents

of IT panel
Resutled in minor
electrical shock

Congested area for

work

touched the panel

Cautionery notice not pasted on IT rack panel

Man Environment
Root Cause Analysis: In the first "Why" write down the probable cause identified from the "Fishbone Diagram". Continue to ask WHY until you no longer can.
(This page must be completed for EACH probable cause identified in fishbone diagram.)

Why?
Cautionery notice not pasted on IT rack panel
Why?
Witness unknowing touched at charged IT rack
Why?
loose earthling wiring in IT rack
Why?

Why? lapse in supervision

Root Cause: Lapses in supervision

“Hierarchy of Health and Safety Controls” will be used to identify controls and countermeasure actions.

Stage 1 - The goal is to eliminate the hazard.

Determine if any actions can be taken to change the task, function, location of equipment or the worker, etc. that would result in the elimination of the hazard from the work. Determine if
substituting different tools, equipment, work methods etc. would result in the elimination of the hazard from the work. Evaluate the proposed solution to identify any hazards created due to change.

Stage 2 - If the hazard(s) cannot be eliminated then a balance (combination) must be achieved within the 5 remaining levels of the "Hierarchy of Health and Safety Controls."
(1) Engineering controls - e.g. machine guards, safety interlocks.
(2) Adminstrative Controls - can be warning signs, warning lines, alarms and horns, flashing lights etc.
(3) Operating Control Procedures - OCP may be required for the individual(s) to safely perform the task e.g. OCP for EOT operation.
(4) Training / Communication - e.g. safety talks, task specific training for related persons.
(5) Personal Protective Equipment - will be identified to protect the worker for any remaining hazards and to reduce residual risks to an acceptable level.
e.g. Safety Goggle, Safety Shoes etc.

Controls Countermeasure / Action Who Due Date Status

Eliminate and / or
Substitute

Engineering controls: live panels shall be revisted for eartling connections GIPL Closed
Adminstrative Controls:
(Warning signs and
devices, Placards, etc.)
cautionary notice shall be placed for electric shock wherever required Mr.Arune Bakale Closed

Operating Control
Procedures: Mr. Vasant
avoid working in cogested area near live panels
(Safe Operating Lohar
Procedures)
Closed
Training / Communication share incident learning points at all safety forums Safety Dept.
Closed

Personal Protective
Equipment (PPE)

Verification & Resolution Questions:

Has this problem reoccurred ? Y [ ] N [n] N/A [ ]
Have the Safe Operational Control Procedures updated ? Y [ y ] N [ ] N/A [ ]
Have Check Sheets or other forms been updated ? Y [ ] N [ ] N/A [ ] If yes, what documents have been updated
Title Supervisor Manager EHS Manager Project Incharge Project Director

Name

Date

Signature