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GODREJ PROPERTIES LIMITED

Incident Investigation Report

(Category 6 to 7)

Ref.No. GPL F HS 21 Date: 20-10-2020

Rev.No.: 00 Page no.: 01 of 04

Site GODREJ 24 Location Tower E 4th floor Date 24.06.2022

A. Event Time & Date :-

Incident Date : 24 6 2022
Incident Time : 11 40 AM

B. Event Type :-
a. First Aid
: c. Minor incident :

non-reportable but
b. Near Miss d. medical treatment injury :
:

C. Injured Person Details :- (NA in case of Near miss & Minor incident )
Name :- first name last name middle name
Employee Number/ID :- Job Title :-
No.
Employment Type :- Temporary : Permanent :
Designation :-
Date of Joining :- Date of Induction :-
NA :-

D. Incident Description :- ( add separate sheet if require )

It was reported that a workman carrying pipe pieces from 7th floor to store area tripped due to improperly wearing safety shoes
but survived the fall as he held the staircase hand rail. No injuries reported.

E. Cause of Incident :-
a. Fall from Height : b. Machinery / Plant :
c. Hot Substances : d. Objects Falling :
e. Transport : f. Hazardous Substances :
g. Handling goods : h. Electricity :
i. Slips/ trips / falls : j. Fire Explosion :
k. Stricking against objects : l. Hand tools :
m. Dust / mud in eyes : n. other, :
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Site GODREJ 24 Location Tower E 4th floor Date 24.06.2022

F. Actual Activity Leading To Incident

a. Using portable plants / equipments : b. Driving :
c. Handling hazardous materials : d. Operating plant / machinery :
e. Grinding : f. Breaking connections :
g. Assembling / dismantling : h. welding / burning :
i. Scaffolding : j. loading / unloading :
k. Draining / flushing : l. Cleaning :
m. Climbing / descending : n. Painting :
o. Working at height : p. Mechanical lifting :
q. Working at depth : r. manual handling :
s. Digging : t other, :

G. Possible Immediate Cause

a. Failure in communication : b. Poor Housekeeping :
c. Inadequate PPE's : d. Failure to follow procedures :
e. Failure to use safety devices : f. Improper Manual Handling :
g. Faulty tools / equipemnts : h. Insufficient time for task :
i. Work environment : j. Misuse of tools / equipments :
k. Fatigue / illness : l. Poor lighting :
m. No supervision : n. Improper maintenace :
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Site GODREJ 24 Location Tower E 4th floor Date 24.06.2022

H. Medical Details :- (NA in case of Near miss & Minor incident )

Part of body affected ( X for the main injury and √ for the other injuries)

a. N/A : b. feets & toes :

c. Chest & Abdomen : d. Lungs :
e. Shoulder, arms, elbow, forearm : f. Multiple Injuries :
g. Eyes : h. Pelvis :
i. Neck & spine : j. Hand, fingures & thumb :
k. Knees, ankle,legs : l. Ears :
m. Head : n. None :
NA :
Comments : -
…………………………………………………………………………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………………………………………..

I. Nature Of Injury :- (NA in case of Near miss & Minor incident )

a. Fatal : b. None :
c. Foreign bodies : d. Sprain / strain :
e. Amoutation : f. Burns :
g. Irradation : h. Crushing Injuries :
i. Asphyxiation : j. Fainting :
k. Fractures : l. Electrical shock :
m. Puncture : n. Exposure to hazardous substances :
o. Drowning : p. Ingestion :
q. Dislocations : r. Bruising with intact skin :
s. Other, Specify : NA :
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Site GODREJ 24 Location Tower E 4th floor Date 24.06.2022

J. Root Cause :-
a. Inadequate Knowledge / skill : b. Inadequate physical / mental capability :
c. Inadequate Equipment : d. Stress :
e. Inadequate planning / procedures : f. Negligence :
g. Inadequate maintenance : h. Inadequate supervision :
i. Inadequate management support : j. Inadequate PPE's :
1 St Root Cause/s (Detail):

1. Workman was wearing his safety shoe improperly which lead to the incident.

K. Correction/s & Corrective action/s :-

1. Workman has been educated on proper usage of PPEs

2. The incident has been discussed in next day TBT

L. Learning From Incident :-

Safety shoes & other PPEs shall be worn properly

Date : 24 : 6 : 2022

Project Manager (Contractor) Project Manager PMC

MR.YRS Yeshwanth MR. Bopiah Sannu

Project safety incharge Project Manager (GPL)