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40 Near Miss

The document is a template for reporting Dangerous Occurrences (DO) and Near Miss Reports (NMR) in construction projects. It includes sections for incident details, nature of the incident, causes, and corrective actions to be taken. Employees are required to fill out this report promptly after observing an incident and submit it to the Site Safety Officer.

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rxhundred95
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14 views2 pages

40 Near Miss

The document is a template for reporting Dangerous Occurrences (DO) and Near Miss Reports (NMR) in construction projects. It includes sections for incident details, nature of the incident, causes, and corrective actions to be taken. Employees are required to fill out this report promptly after observing an incident and submit it to the Site Safety Officer.

Uploaded by

rxhundred95
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Ref. No.

: BAE/R/EHS/DO/NR/40/R0
DANGEROUS
OCCURRENCE (DO) / NEAR Frequency: When Near Miss Occur
MISS REPORT (NMR)
Building Architecture Engineering
Type of
DANGEROUS OCCURRENCE (DO) NEAR MISS REPORT (NMR)
Incident
Project Name: Exact Location of Near miss:
Site Details
Date: Time:

Description
of Incident

Manual Material
Excavation Concreting Roof Works
Handling
Work in Confined
Rock Blasting Vehicle Movement Painting
Space
Activity Electrical
involving of Working at Height Welding Finishing
Maintenance
Incident Shuttering Cutting Bar Cutting & Mechanical
(Tick the
Bending Maintenance
relevant De-shuttering Grinding Bar Shifting Work near IR Track
Activities) Scaffolding Lifting Bar Binding Work near Live OHE
Assembling Line
Scaffolding Erection Grit Blasting Offshore Work
Dismantling
Road Work Stringing Shot Blasting Any Others

Fall of Material or
Drowning Vehicle Movement
tools Failure of Shuttering
Nature of Support Grinding wheel
Failure of Tools Oil spillage
Incident failure
Unsafe Material
(Tick the Failure of Plants Fire Chemical spillage
Handling
relevant Nature)
Wrong Rigging
Flying object Gas leakage Any Other:
method
Slip, Trip & Fall Electrical Shock Soil Collapse

A. Plant & Equipment Ill Health E. Management Issue F. Procedural


failure Poor administrative Violation
Defective equipment. C. Construction control. Non-compliance of
Methodology
Failure of equipment Planning deficiency. procedure.
Inadequate detailing
Parts. Inadequate Inadequate
of work in Method
Manufacturing defect. supervision. procedure.
Statement.
Defective Electrical Improper resource SIMOP guideline
Causes of equipm. Missing Schematic allocation. violation.
Incident Over Aged equipment. Drawing for Policy not adequately
temporary structures.
(Tick the Poor Maintenance. defined, disseminated G. External Factors
Adverse Weather
appropriate Error in equipment D. Training & or enforced.
Causes) condition.
selection. Awareness Poor Housekeeping.
Poor Road condition
No training provided.
B. Personal Factor Power failure.
Inadequate job related
Lack of Skill Natural Calamities.
training.
Behavioural issue.
Insufficient refresher H. Others
Poor Workmanship
training.
Poor Communication
Missing Signages &
Caution Board.
Direct
Cause
Root Cause

NMR / TPL @ 2020 Page 1 of 1


Ref. No.: BAE/R/EHS/DO/NR/40/R0
DANGEROUS
OCCURRENCE (DO) / NEAR Frequency: When Near Miss Occur
MISS REPORT (NMR)
Building Architecture Engineering

Near Miss
Name & Designation
Reported
Of Employee:
By

Photograph
s if any

Sl Action to be taken Complian Evidence Remark


Action by Target
Corrective no ce status Picture s
Action
Taken

*Note: This report should be filled in by any Employee who is reporting the Dangerous Occurrence / Near
Miss soon after the observation. This Form shall be submitted to Site Safety Officer.

NMR / TPL @ 2020 Page 2 of 1

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