NEAR MISS REPORT

A near miss is any event that has the potential to cause personal injury (Major or Minor) any loss of productivity, any
environmental damage or any property damage.
‫الحادث الوشايك هى أي حدث ذا احتمال وقوع اصابة للشاخاص )كبيرة و صغيرة( أو خسارة فى الناتاج أو ضرر للبيئة أو الممتلكات‬

DETAILS OF NEAR MISS / INCIDENT ‫تفصيل الحادث‬

1. Date ( ‫)التاريخ‬ : 4-03-2019 2. Time (specify am or pm)(‫)الوقت‬ : 8:50 am
3.Location(‫)المكان‬ : Near factory main gate
4. Description
The following is an account of what happened ‫سبب وقوع الحادث‬ /
(‫)وصف الحادث‬ :

While entering a trailer truck inside from factory main gate, its tires came contact with the corner of stacking pla
due to this it two tires became defective.

INVESTIGATION FINDINGS AND FOLLOW-UP ACTIONS ‫ناتج التحقيق و الجارائات المتخذة‬

I believe this could have resulted in injury and/or damage to: (‫أعتقد أن التالي كان من الممكن ان يحدث )اصابة أو ضرر‬
 Personnel ‫صصصصص‬/  Property ‫ صصصصص‬/  Equipment ‫ صصصص‬/
1. Risk Potential ‫ صصصصص صصصصصصص‬/ :  Minor ‫صصصصص‬  Major ‫صصصصص‬
2. Findings ‫ صصصصص صصصصص‬/ : If these Circumstances Occurred ‫ صصص صصصص صصص صصصصصص‬/
1- |Driver did not have any assistant while entering.
2- Driver judgment was not accurate.
3- Gate was not fully opened to enter the truck easily.
The following measures to be taken to prevent this
Action By
from occurring in the future Wh
3. Recommendations ‫صصصصصصصص‬/: ‫صصصصصص‬
‫صصص صصص صصص صصصصصصصصصصص صصص صصص صصصص صص صصص صص‬ ‫صصصص‬
‫صصصصصصصص‬
‫صصصصصصصص‬
1- Security help drivers while entering vehicles. Hr. imme
2- Door must be opened according to size of the truck Security
3- Provision of Flag man production

Reported by Production Manage

Safety Officer/ Engineer/ Safety
‫صصصصص صص‬ ‫صصصص صصصصصصص‬
Representative
Name : M.Imtiaz ‫صصصصص‬: Name : ‫صصصصص‬: Name :
ID No. :17191 ‫صصصصص صصصصصصص‬: ID No.: ‫ صصصصص صصصصصصص‬: ID No.:
Sign : ‫ صصصصصصص‬: Sign : ‫ صصصصصصص‬: Sign :
Date : 4-03-2019 ‫صصصصصصص‬: Date : ‫صصصصصصص‬: Date :

NEAR MISS / INCIDENT REPORT

Distribution:
F03-TSM-HSE-OP-01 Rev. (0) Page 1 of 2
Original : Safety Department,
Copy : QHSE Manager / Parties & Personnel in charge of taking the above mentioned corrective actions

F03-TSM-HSE-OP-01 Rev. (0) Page 2 of 2