/ NEAR MISS REPORT

Ref. CLC-OHSE-MS-72 Rev.01 Date: 20/07/2021

NEAR MISS REPORT

A near miss is a potential hazard or incident that has not resulted in any personal injury but has the
potential to do so.

Please complete this form as a means to report & record a Near-Miss situation

Department/Location: ___Logistics Department_____ Date: __17. Sept. 2021______

Time __1:05pm____

Description of Near Miss Event (please give as much detail as possible)

65146 - LV - Hyundai Starex, Over Speeding - 80 kph,
In Vehicle Monitoring System (IVMS) control screen has reported a continuous violation on daily bases.
Some other reports showed the device as disconnected. Logistics coordinator has communicated the driver
and has come up with a result that the devise raises alarms from time to time.

Errors of IVMS devise may lead to bad consequences such as; accidents, and bad feedback from clients.

Reported by who (print & Sign) …Abdul Rahman Abdul Razaq……………………….

Report accepted By (Print & Sign) …Salah Abdul Razaq……………………….

Out come of event (investigator/Manager) Please tick all appropriate conditions:

Unsafe Act  Unsafe equipment 

Unsafe Condition  Unsafe use of equipment 

Corrective action taken (Remove the hazard, replace, repair, or retrain, Review procedures for the
task).
Vehicle has been stopped of work,
Near miss is Reported to Company general manager, Logistics Manager, and QHSE manager.

Manager Responsible for implementation of corrective actions……Logistics Manager………

Date Report & Actions Completed……Sept. 18, 2021……………………………