NEAR MISS REPORT

DATE & TIME 1/25/2020 15:50

EXACT LOCATION CONTRACTOR'S FABRICATION YARD & STORE ROOM

Electrician was testing for the trial of Pug cutting machine to check either the status of
DESCRIPTION condition was okay or not, for inspection purpose. While testing electrical circuit got
tripped.

Disconnected the connection & Informed about this incident to supervisor present
Immediate Action Taken near the site immediately, who informed the concerned department member available
at that time.

Reported By Department Name Signature

Krishna Sharma Raj Engineering services

Reported To Department Name Signature