Incident/Accident Report

Unit /
Date 16/02/2018 Location Channasandra
Site Kolar -MI
INFORMATION ON THE INCIDENT/ACCIDENT
1 Nature of The activity PIPE LAYING WORK
2 Location of the activity Channasandra
3 Date of the incident/accident 16/02/2018
4 Time of the Incident/accident 1:30am
5 Weather Conditions (if apply) COLD
Name of the in charge person with
6
Designation
Mr.Uma Shanker(Sr. Engineer)
7 Brief Description of the Incident/Accident:
At Channasandra Pipeline site, midnight around 01:30am. Some of the drunken
localities beaten our Engineer(Sanjeev Dubey) and Vehicle driver(Anji). Our Engineer
got minor injuresin his neck and have been admitted in Hospital(Suraksha Hospital).

INFORMATION ON INJURED PERSON OR OWNER OF DAMAGED PROPERTY

Name Sanjeev Dubey Date of Birth/Age 28

Address Meil Staff

Phone
9900489376 Home :
Numbers

Describe Nature of
5 Minor Injuries in his neck
Injury/Damage of property

Unsafe Acts/Conditions which

6
caused
NA

7 Safety appliances (Relevant) used Helmet ,Shoe ,Reflective jacket

8 Corrective action taken

MEIL/SAFETY/F-05/Rev.02
 NA
9 Preventive measures

10 Witness with signatures

1.Anji(Driver)

11 Injury Minor injuries in his neck

Signature of the Safety Officer Signature Project Head.

C.KUMRESH Mr.B.VIJAY KUMAR

MEIL/SAFETY/F-05/Rev.02