INDIAN OIL CORPORATION LIMITED

(MATKETING DIVISION)
CHITTOOR LPG BOTTLING PLANT

Format No- F2
ACCIDENT / INCIDENT (NEAR MISS) REPORT

(To be submitted by contractor after every Accident/ Incident within 24 hours)

Report No.:____________________

Name of Site:____________________

Date:_________________

Name of work:____________________

Contractor:___________
Type of Accident/ Incident: Near Miss Minor Loss Time
Fatal
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Name of the injured:
Age
Father's name:
Sub-contractor M/s:
Date & time of Accident/ Incident:
Location:

Brief description of Accident/ Incident

Cause of Accident/ Incident

Nature of injury/damage

Medical Aid provided/actions taken

Intimation to local authorities (if applicable)

Signature of contractor With seal