HEALTH & SAFETY ACCIDENT / INCIDENT NOTIFICATION

PROJECT /FACILITY DETAILS:

Incident 01/Coimbatore/2017-
Operating Unit: Coimbatore Branch- India/SZ-1,
No: 2018
Project / Facility Name Project
Living Art LA Mognolia Apartment. Location: Salem 4-44-S0538
& Location: No:
Project / Facility
Mr. V.Anup Kumar, Branch Manager, Coimbatore
Manager’s Name:

Subcontractor: Nil

NI Service Repair Mod Dismantling

Project Type: Manufacturing
Elevator Escalator Moving Walk 3rd Party Commuting Other

INITIAL ACCIDENT / INCIDENT CLASSIFICATION:

Personal Injury: Fatal Serious Injury TRC MTC Other [TP-Near Miss]

High Potential Incident: Fatal Potential Serious Injury Potential

INCIDENT DETAILS:
Location of accident /
Incident:
Process or Task at time
of accident / incident:
Incident Description:
(Briefly describe what
happened – facts. Attach
additional pages or
photographs if required)
Date &
Top floor 30-10-2017, 04:40 pm
Time:
Lift in normal running condition
At around 4:40pm employees in reception heard a “Dong” sound inside the shaft. They checked that
the lift was not working so they booked at call center around 04:43pm. Our route technician
Mr.Gnanaprakash along with service manager Mr.Subash, reached site at 05:25pm. They observed
that our lift was in overshoot condition and the counter weights are buffered. Our technician put the lift
in shutdown and leave the site since equipment and manpower support required from the branch.
Name & ID No: Occupation & Dept: Employee Type:

Injured / Involved No persons were travelling inside Direct Employee

Person Details: the elevator at the time of
Indirect Employee
overshoot

Type of injury: Nil Body part injured: Nil

External Medical No Details of medical facility injured person sent to:

Treatment Required: N/A
Yes
Immediate Actions
Taken: (Describe what Our technician put the lift in shutdown and leave the site since equipment and manpower support
immediate actions were taken required from the branch
– include medical treatment).
Name of assigned
Lead Investigator:
Date &
Incident Notified by: M.Subash / Service Manager 31-10-2017, 10:00am
Time:

NOTIFICATION:
Incident Category Persons to Notify Timing
Project Manager notifies Branch Manager ( Site to Branch Level) Immediate
Branch Manager notifies OU Managing Director / OU H & S Manager
Immediate
(Branch to OU Level)
OU Managing Director notifies TKE AP CEO/ VP H& S ( OU to TKE AP
Within 2 Hour
Fatality and Serious Injury Level)
TKE AP CEO notifies TKE AG CEO & AP VP H&S notifies TKE AG
Within 4 Hours
Global H&S Manager (TKE AP to TKE AG Level)
Project Manager notifies Branch Manager ( Site to Branch Level) Immediate
High Potential Incident, TRC Branch Manager notifies OU Managing Director / OU H & S Manager
Within 8 Hours
(Branch to OU Level)
OU H&S Manager notifies VP H& S ( OU to TKE AP Level) Within 24 Hours

Oct 2014 Page 1 of 2 TKEAP –HS-FM-02B (01)

 HEALTH & SAFETY ACCIDENT / INCIDENT NOTIFICATION

Preliminary information Only – Investigation will determine causation factors and lessons learnt will be
presented in the Accident Bulletin.

ATTACHMENT 1- PHOTOGRAPHS

Please insert relevant photographs below & attach any other relevant information to the back of this accident / incident
notification.

1. Lift in Overshoot condition (Front view) 2.

3. Shoe condition 4.

Oct 2014 Page 2 of 2 TKEAP –HS-FM-02B (01)