INCIDENT REPORT Description report

(Must be competed as soon as possible after the incident is o

reported but certainly within 24 hours of being notified Report N : 01
regardless of the time of the day or day of the week)
General Data:

1. Project/ Contract No: Design and Build for the Standard Gauge Railway (SGR) Line
from Mwanza to Isaka Project

2. Reporter Mr.ZAKARIA 12/03/2023

KINGDOM
MWANJISI
(Date)
3. Name(s) of 1. Mr.Yese Date of Birth: 01/01/1991
Chilewa
Subcontractor No
(Labour).
Victim(s)
Designation: Labour
Nationality: Tanzanian
Work 02 Years
Experience
(Yrs.):
4. Location of Incident: Lohumbo crush Date of Incident: 12/03/2023
Time of 07:58 AM hrs Day
Incident:
5. Names of Possible Samwel Mwaluku (electrician)
witnesses:

6. Incident Potential Rating Medical Treatment Injury (MTI)

7. Description of the incident

An incident occurred at Lohumbo crush around 07:58 a.m during day shift working hours
12.03.2023. The situation of incident happened when Mr.Yese Chilewa physical attacked by Mr.
Wanzagi Lugendo

Cause of incident
A victim namely yesse chilewa convicted of theft by taking and carrying away the property (phone) of
another worker without permission from the owner.
Property damage.
No damage happened
8. Consequences of Incident: Minor Injury (MI), Medical Treatment Injury (MTI), Lost

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 Time Injury (LTI), Fatal Injury (FI), or Property Damage (PDI):

According to the investigation; the incident caused Medical Treatment Injury (MTI)
9. Description of Property Damage:
No any property damaged.
10. Likely Cause of the incident
Theft (taking property without permission of the owner.)
11. Required Remedial and Corrective Actions
I. First aid was provided to the victim.
II. The victim reported to police station.
III. The victim (worker) was sent to the hospital for further treatment.

12. List of Follow-up Activities

i. Workers should not take other people’s property without permission.
ii. Workers should not engage in violence or physical attack, they should follow Grievance
Redress Mechanism (GRM) procedures to solve their conflicts.
iii. Workers should take care of their properties.

13. Follow up safety training

As mentioned above.
14. Verification and Close Out

Mechanism of Injury (indicate all relevant)

15.
Slip//trip/fall: NO Manual handling: YES Body Stressing: NO

Being Hit by falling object: NO Hitting an object with NO Being hit by NO

part of the body: moving objects:

Exposure to heat/ NO Exposure to biological NO Exposure to NO

radiation/ electricity: agent (including body Chemical agent:
fluid):

Exposure to work stress: YES Violence: YES Other inappropriate YES

behaviours:

Other

16. Nature of Injury (indicate all relevant)

YES Fracture
Sprain/ Strain NO Cuts/ Scratch/ NO
Abrasion

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 NO NO
Bruising NO Burn Bite/ Sting
NO NO
Electrical shock NO Concussion Psychological
Dent NO Beat YES
17. Photographs

Photo indicate the face of the victim (worker).

19. Reporter
Mr. ZAKARIA KINGDOM Z.K.Mwanjisi
MWANJISI (Signature).
Name – Safety Officer

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