Issued By: HSE DEPT

Document Code HBF-IMS-FORM

INCIDENT REPORT Document S/No.

Rev. No.
FM-HSE- 018
02
Issued Date 12-09-2017

Date 02-10-2021 Factory Others: (Please specify)

Place/Area of
Report No. 02 Incident Site

Company Name Hard Block Factory Time 1.15 PM Activity Wheel loader

Satbir Singh ID No. 4010 Position Wheel loader Operator

Name of the Bus Driver
Sanjeev Kumar ID No. 2286 Position
Person Involved
ID No. Position
In-Charge Mr. Johnson Engineer Mr. Abraham Mathews

Details of Incident (Explain What was Done, By Whom and Where?)

On 02/10/2021 around 1:15pm a wheel loader operator Mr. Satbir Singh (HBF) and a minibus driver Mr. Sanjeev Kumar
(HPBS) were involved in a synchronized reverse accident.
It was observed during the investigation that Mr. Satbir Singh was reversing the wheel loader from chamber 07 after filling
the aggregate hopper. Coincidentally, the minibus revised out from the workshop at the same time, he quickly stopped the
bus and blasted his horn when he noticed the wheel loader was reversing to his direction. Unfortunately, the wheel loader
collided with minibus from the rear which resulted into the bus rear bumper and light damages.
Witness Name: Mr. Yassine Signature:

Brief Description of Injury (if any)

Injury-free

Accident Near miss Reported By Vishakh Francis

Human Injury Fatality Environmental Pollution Major

Medical Treatment Restricted Work Property Damage Minor
Permanent Disability Lost Time Injury Equipment Damage Negligible
Dangerous Occurrence Others (Please specify)

Investigation and Cause of Incident (Immediate and underlying cause)

 Negligence of wheel loader operator.
 Lack of clearly signposts and segregation.
 Steep gradient from the hopper.

Immediate Action to Eliminate the Incident

 Accident area properly segregated.
 Supervisors were contacted.

Further Recommendations to Prevent Recurrence of Incident

 Provision of safety devices such as reverse cameras for the wheel loader.
 Refresher training for both drivers.
 Keep private vehicles, delivery vehicles apart where possible.
 One way system (avoid the need to reverse).

Remarks
 Issued By: HSE DEPT
Document Code HBF-IMS-FORM

INCIDENT REPORT Document S/No.

Rev. No.
FM-HSE- 018
02
Issued Date 12-09-2017

Production Engineer HSE Inspector

HSE Manager Operation manger CIC General Manager