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  • Incident Notification Form

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    mohamed atef
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    A near miss incident report from June 24, 2020 describes an unsecured drainage manhole cover in a production hall that could have led to a personnel injury if someone had fallen inside. Cleaning laborers had left the cover open without securing it. The immediate action taken was informing the supervisor of the cleaning laborers to close the manhole cover. The report was issued and reported on the same day by Mohamed Atef.

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    A near miss incident report from June 24, 2020 describes an unsecured drainage manhole cover in a production hall that could have led to a personnel injury if someone had fallen inside. Cleaning laborers had left the cover open without securing it. The immediate action taken was informing the supervisor of the cleaning laborers to close the manhole cover. The report was issued and reported on the same day by Mohamed Atef.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    7 views1 page

    Incident Notification Form

    Uploaded by

    mohamed atef
    A near miss incident report from June 24, 2020 describes an unsecured drainage manhole cover in a production hall that could have led to a personnel injury if someone had fallen inside. Cleaning laborers had left the cover open without securing it. The immediate action taken was informing the supervisor of the cleaning laborers to close the manhole cover. The report was issued and reported on the same day by Mohamed Atef.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
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    HEALTH, SAFETY and ENVIRONMENTAL INCIDENT REPORT

    Date of incident 6/24/2020 Time of incident 12:00 PM

    Incident classification:

    Accident Nearmiss Observation Yes

    Incident Type:

    Property/Equipment Damage Injury / FAC Yes Fire Environmental

    Equipment involved (Please advice type of equipment/ machinery being involved)

    Drainage manhole cover

    Briefly Describe Incident: Describe what happened (DO NOT use people’s names or any medical diagnosis):

    Cleaning labors left one of the drainage manhole covers opened and wasn’t secured that could lead to falling of personnel inside and finally will result in an injury

    Location of incident (Detailed description of location):

    Inside the production hall

    Imemdiate action taken:

    Informing Nada ( supervisor of cleaning labors) in order to close the manhole cover

    Person responsible for work activity at time of incident:

    Employee Yes Subcontractor Client Other (please advice)

    Personnel details:

    Name ID Profession

    Report issuance date 6/24/2020

    Reported by Mohamed Atef

    Photos (Upload clear descriptive photo)

    No photo No photo

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