PLEASE PRINT OR TYPE L9.

12 (08/2014)

PROJECT MANAGEMENT
CONTRACTOR NEAR-MISS AT WORKSITE REPORT

Department: * GCPD Division: * HUGRSP Div. SAP Orgcode: * 30026283

Observer's Name: * Muhammad Anwar Hussain Badge Number: * 2481144711

Contractor Company Name: * Br. CAT International Co., Ltd. BI Number: * 10-14224
BI Number Format: XX-YYYYY-ZZZZ Ex. BI-10-00019-0004

Incident Date: * 09/01/2021 Incident Time: * 08:30 Persons:

PPE: Material: Stacked unsafely/excessive/not protected (choose X if applicable)

PTW (Permit to Work): Work Procedure:

Elevated Areas: Electrical:
Heavy Equipment: Hot Work/ Welding & Cutting:
Tool: Trenching & Excavation:
Vehicle: Barricade: Confined Space entry:
Ground Level: Environmental & Health Issue:
Note: - Fields with asterisk ( * ) are mandatory fields and must be filled out.
Observation Area: HUGRS New GGM

Describe What During the painting preparation, a worker engaged and open the valve of the compressor. Suddenly, the end
Happened? of hose was detached and went swinging in the air. A worker nearby was almost hit on the face when he was
trying to shut off the compressor.

Analysis - Why did A worker was almost hit on the face when the end of the hose of the air compressor went swinging in the air
it happen? when it was energized.

Immediate Action Immediately conducted on the spot TBT regarding air compressor safe operations
Taken:

Recommended Site in charge to always monitor the activity for any hazards present and to ensure that all personnel are
Future Corrective aware of the hazards when operating air compressor
Action:

Confirmation of Corrective Action Implementation: On the spot Next site visit Others

Other Issues Not N/A

Covered By The Card
(Please Specify)

Positive N/A
Observation
(Please Specify)

Reviewed By (Supervisor Name): EEVER PAUL C. DE LEON

USERID: 2456204425
Company: BR. CAT International Company Ltd.
Date: 09/02/2021 Time: 09:30
Br CAT International Co., Ltd.

• Painting supervisor gives briefing to his crew regarding air compressor

safety operations