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Project Name Elementis Specialist


Location Taloja MIDC, Navi-Mumbai

Date of lncident 25t6t2020 Time of lncident 12:45 pm

Names of person Mr. Abhay Kumar


involved
Names of Witnesses NA

Type of incident Near Miss

Body Part affected NA


(lf aoolicable)

lnvestiqation Tvpe (if in doubt, please contact your HSE Advisor)


Level Safety Environment Danqerous incident {near miss)
One First Aid Treatment (FAl) or Medical No environmental damage An incident where a person is exposed to
Treatment lnjury (MTl) where worker a risk that could have resulted in a First
Environmental hazard identified. On-
returns for their next shift. Aid lnjury or Medical Treatment lnjury
site release of pollutant. (<20 litres/Kg)
only.
Two lnjury or illness resulting in Lost Time. (LTl) Onsite or offsite release of pollutant that An incident where a person is exposed to
causes land, air or water contamination. a risk that had the potential to cause a
FAI or MTI that had the potential to be a
Lost Time lnjury. (LTl)
Lost Time lnjury. (LTl). Onsite or offsite release of pollutant that
is notifiable to a government agency.

OBSERVATION / INITIAL CAUSE


The UG tank slab concreting work was going on. There was a movement of transit miller for concrete pouring. One of the
TM (MH 46 - BM-2216) was stuck and inclined one side due to wheel of the TM go down into the ground.

IMMEDIATE ACTION
1. Barricaded the area and movement of person immediate stopped
2. Concrete from TM started get down with the help of tough rider till the empty of TM.
3. Clear the soil and boulders beneath the wheel.
4. TM was driven in reverse position and get free from stuck

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fatmH. R' Construc'tiotr
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ProP' H' P' Pawali

Document Name: Conect as at: Pagg Ng,

Point NO 14 .Near Miss reporl 05 03 Apr 14 I ol2


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lNSERT PHOTOS
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ROOT CAUSE
1. Vehicle movement path not defined
2. Non compaction of ground
3. Lack of supervision

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Vehicle movement path shall be defined. RR Construction 27"'June2020
Compaction of vehicle movement path shall be done. RR Construction To be discussed

SIGNATURES
lnvestigating Officers Shrikant Nalawade Position Project Manager
Name
Signature Shrikant Nalawade Date 25-June-2020
nvestigating Officers
I Davalsab Kumbhar Position Safety officer
Name
Signature Davalsab Kumbhar Date 25-June-2020

fgr B. R. Construction

Document Name: Pgge No,

Point NO 14 .Near Miss report

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