FORMAT NO. : 13.02.

07/F-03
DANGEROUS OCCURRENCE
(DO) / NEAR MISS REPORT Rev: 01
(NMR) Report No:

Incident Date & Time:_17/06_/2021_ & 09_:30_Hrs. DO/NM Reporting Time: 09:32_Hrs. Shift: Day □ / Night □
ype of Incident DANGEROUS OCCURRENCE (DO) NEAR MISS REPORT (NMR)
Project Name: NPB Site New Delhi Exact Location of Near miss/DO: Rajya Sabha
Site Details
SBG: Urban Infra SBU: Buildings and Airport

Description of On 17/06/2021 @ 9.30Hrs, Concrete boom placer (JH- 05 A6215) was trying to place concreting, during the reversing Concrete
Incident boom placer was toppled in raft from main vehicles roads (5M depth) near gate number 8. Mr Wasim (Operator S/C Tara
Chandra) was continuously working around 50 hrs, the main root cause because of which this incident occurred..

Manual Material
Excavation Concreting Roof Works
Handling
Rock Blasting Vehicle Movement Painting Work in Confined Space

Activity Working at Height Welding Finishing Electrical Maintenance

involving of Shuttering Cutting Bar Cutting & Bending Mechanical
Incident Maintenance
(Tick the relevant
De-shuttering Grinding Bar Shifting Work near IR Track
Activities)
Scaffolding Assembling Lifting Bar Binding Work near Live OHE
Line
Scaffolding Dismantling Erection Grit Blasting Offshore Work
Road Work Stringing Shot Blasting Any Others

Fall of Material or
Failure of Shuttering Drowning Vehicle Movement
tools
Nature of Support
Incident Failure of Tools Grinding wheel failure Oil spillage
(Tick the relevant Failure of Plants Unsafe Material Handling Fire Chemical spillage
Nature)
Flying object Wrong Rigging method Gas leakage Any Other:
Slip, Trip & Fall Electrical Shock Soil Collapse

A. Plant & Equipment failure
Defective equipment.
C. Construction Methodology
Failure of equipment Parts.
Manufacturing defect.
Defective Electrical
equipm.
Causes of Over Aged equipment.
Incident Poor Maintenance.
(Tick the appropriate
D. Training & Awareness
Causes) Error in equipment
selection.
B. Personal Factor
Ill Health
Inadequate detailing of
work in Method Statement.
Missing Schematic
Drawing for temporary
structures.
No training provided.
Inadequate job related
training.
E. Management Issue F. Procedural Violation
Poor administrative Non-compliance of
control. procedure.
Planning deficiency. Inadequate procedure.
Inadequate supervision. SIMOP guideline
Improper resource violation.
allocation. G. External Factors
Policy not adequately Adverse Weather
defined, disseminated or condition.
enforced.
Poor Road condition
Poor Housekeeping.
Power failure.

Lack of Skill Insufficient refresher Natural Calamities.

Behavioural issue. training. H. Others

Missing Signages & Caution
Poor Workmanship
Board.
Poor Communication
1. Construction vehicles movements HIRA shall be followed during vehicles entering in site the premises.
Corrective
2. Administrative control to be taken during deployments of vehicles operators.
Action Taken
3. Edge protection area/lengths to be increased.
Near Miss Name & Designation
Reported By Of Employee: Deepak Jaiswal/Kishore Panchal (Site engineer and P&M Engineer)

NMR / TPL @ 2020 Page 1 of 1

 FORMAT NO. : 13.02.07/F-03
DANGEROUS OCCURRENCE
(DO) / NEAR MISS REPORT Rev: 01
(NMR) Report No:

Incident Date & Time:_17/06_/2021_ & 09_:30_Hrs. DO/NM Reporting Time: 09:32_Hrs. Shift: Day □ / Night □
Photographs if
any

Distribution

*Note: This report should be filled in by any Employee who is reporting the Dangerous Occurrence / Near Miss soon after the
observation. This Form shall be submitted to Site Safety Officer.

NMR / TPL @ 2020 Page 2 of 1