thyssenkrupp Elevator India

NEAR MISS INCIDENT AND FIRST AID RECORD FORM

PERSONAL DETAILS OF INVOLVED
Name - ID - Occupation - Employee Subcon
Employer - Branch Coimbatore Department NI/MOD/SER/OFC/MPF/Other
Known Illness including Medication - DOB -
INCIDENT/ACCIDENT DETAILS Date 03-12-17 Time 08:45am INJURY / ILLNESS DETAILS
CLASSIFICATION
Location Vaishnavi Apartment (4-43-SO071)-Madurai
Work Process Being Performed; Before / During Incident Incident
-
Lift in normal running condition for customer use Injury
Incident/Accident Description (Summarise the sequence & consequence) Illness
On 03/12/17 by 08:45 apartment representative called the elevator from 2nd floor he
observed that lift is on 3rd floor but not coming down. He went to 3rd floor and found lift is
on floor level but not moving. After few minutes resident from 1st floor found smoke
coming from shaft entrance. The same informed to apartment representative therefore he
called the route incharge. Route incharge asked him to go to machine room to ensure
whether MCB is switched off. Customer reported it has already been tripped and machine
room is full of smoke, he didn't observe any fire. By 09:15 Route in-charge B.Rajasekaran
reached and he observed MCBs were tripped, excessive smell from controller, contactors
in melted condition. By 09:30 he shut down the elevator. MCB has been locked out and he
informed supervisor by 09:38. Supervisor gave a message to safety incharge by 11:21am.
FIRST AID TREATMENT GIVEN ACTIONS

Back to Work

Hospital

- Doctor / Clinic

Reported to Supervisor

Require ICAM Investigation

First Aid Treatment Given By (INDICATE / MARK THE INJURED BODY PART)
Signature -
Name -

Investigation Work Place Supervisor/Manager Branch Safety Executive - Comment Branch Manager - Comment
Findings
Direction contactors (URU1,2) short circuited. Investigators (Mr. Cyril & Gobi) are
Primary Causes Direction contactor burnt. It may be due
It should have been properly checked and of similar opinion. Service Supervisor
of Incident? to short circuit of contacts/ high voltage
replaced during repair work. also agreed to same.
Deviations
Missed out the proper checking of Recapturing a 2 years old unused elevator
Resulted in Proper process not followed.
components. without QC inspection.
Incident
Multiple competent personals to be
selected for assessment and review of
QC and safety inspection can be carried
QC inspection has been made mandatory for health of machines before considering
out along with service executive before
future recapturing of elevators for repair/AMC. (Proposed – Service
recapture / major repairs/MOD
Mr. Mohan N. & Mr. Hariharan QC-
Control Actions Mr. Gobi & Safety - Mr.Cyril)
Being
Implemented 4 Stage NI inspection procedure &
INS 03 to be conducted for review by
Without approval in set of documents, Only repair person should do repair work if
the team in charge and this report will
proposal will not be submitted to done by others then proper approval and QC
be send for HQ review and
customer for unit adding in to UUM. check should be done and recorded.
confirmation before repair/AMC order
booking in future.
Signature
Date
Name

REVIEW BY ZONE SAFETY MANAGER

Signature
June 2016 Page 1 of 1 tkEAP-HS-FM-005A (00)
 Date:
DISTRIBUTION: Original to: MC / Branch H&S Manager, Copy retained in the book at MC/Branch office.

Apr 2008 Page 2 of 2 LIL-HSE-FM-015A(01)