Accident/Incident form

Project: Ishwarya health care project

Name of Contractor/Sub contractor:

Name/Age/ sex of Victim or Person Involved: SHAHEEB, SHAMIR, UJJAL & HASHEEM.

Date and Time: 18-03-2023 & 12pm

Location: 9th Floor

Description of Incident/Accident:
(Brief narration how it occurred)

it was observed that the above mentioned 4 workers are working at height for
plastering work on standing on the scaffold. When workers need to work at 8 th Floor
needs to shift the platform from 9th to 8th floor, while transferring the platform it got
slipped from workers hand and got hit by the scaffolding ledger pipe got reached out
the residential house. Due to this accident no one is got harmed/injured and no
property damage has occurred.

Nature of Damage /Injury: Near miss

Witness (if any): ground Floor workers.

Observations:
1. Failed to erect scaffold with proper working platform at each floor.
2. Failed to follow proper shifting of materials methodology.
3. Failed to tie the guide rope for shift materials.
4. Failed to put peripheral net and safety net while working at height.

Cause of Accident/Incident:
1. Unawareness regarding safe work practice.

Corrective action taken/suggested for Prevention of recurrence:

1. Need to provide safe working platform at each floor.
2. Need to provide peripheral net and safety net

Signature :
Date :
Name :
Designation :

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Format No.-B-EHS-04 Rev. No.-01