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    Preca Solutions India PVT LTD: Accident / Incident Investigation Report

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    MURTHY
    This incident report summarizes a workplace accident that occurred at Preca Solutions India Pvt Ltd. It provides details about the date and time of incident, those injured including their names and ages, and the body parts injured. The type of incident is classified as a lost time injury. The investigation found the cause was improper equipment installation and lack of communication. Witnesses were interviewed and the site was observed. Contributing causes included physical hazards and people causes. Corrective actions taken included administrative controls and recommendations. An investigation team signed off on the report.

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    Preca Solutions India PVT LTD: Accident / Incident Investigation Report

    Uploaded by

    MURTHY
    28 views8 pages
    This incident report summarizes a workplace accident that occurred at Preca Solutions India Pvt Ltd. It provides details about the date and time of incident, those injured including their names and ages, and the body parts injured. The type of incident is classified as a lost time injury. The investigation found the cause was improper equipment installation and lack of communication. Witnesses were interviewed and the site was observed. Contributing causes included physical hazards and people causes. Corrective actions taken included administrative controls and recommendations. An investigation team signed off on the report.

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    This incident report summarizes a workplace accident that occurred at Preca Solutions India Pvt Ltd. It provides details about the date and time of incident, those injured including their names and ages, and the body parts injured. The type of incident is classified as a lost time injury. The investigation found the cause was improper equipment installation and lack of communication. Witnesses were interviewed and the site was observed. Contributing causes included physical hazards and people causes. Corrective actions taken included administrative controls and recommendations. An investigation team signed off on the report.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    28 views8 pages

    Preca Solutions India PVT LTD: Accident / Incident Investigation Report

    Uploaded by

    MURTHY
    This incident report summarizes a workplace accident that occurred at Preca Solutions India Pvt Ltd. It provides details about the date and time of incident, those injured including their names and ages, and the body parts injured. The type of incident is classified as a lost time injury. The investigation found the cause was improper equipment installation and lack of communication. Witnesses were interviewed and the site was observed. Contributing causes included physical hazards and people causes. Corrective actions taken included administrative controls and recommendations. An investigation team signed off on the report.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    of 8

    PRECA SOLUTIONS INDIA PVT LTD

    ACCIDENT / INCIDENT INVESTIGATION REPORT

    Department: Location :
    Date & Time of Incident :
    Brief of Incident :

    Name Of Injured Person Designation Age:


    1
    2
    3
    Body Part Injured:

    Type Of Incident :
    Lost Time Injury

    Occupational Illness Dangerous Occurrence /Near Miss

    Classification Of Incident :
    Unsafe Act

    Cause Of Incident Or Condition

    Lack Of Attention Poor Documentation

    Failure to follow proper procedure Improperly Prepared Procedure

    Lack Of Communication Congested Area

    Unfamiliar With The Equipment See below Poor Design

    Unfamiliar With Operating Procedure Improper Equipment

    Carelessness Improper Installation

    Any Other ( Pls. Specify)


    Description Of Incident:

    Initial Response & Reporting

    Prepared by Safety Officer / Site Incharge


    Name
    Signature
    ACCIDENT / INCIDENT INVESTIGATION REPORT

    Facts Gathering

    Key Witnesses Interviewed People):


    Name : Details of Input
    1
    2
    3
    4
    5

    Observations / Findings at Site & Records:


    1

    2
    3

    Contributing Causes
    Physical Causes:

    People Causes:

    System Causes:

    Corrective & Preventive Actions Taken


    Elimination:

    Administrative Controls:

    Recommendations
    Sr.No. Recommendation

    2
    3
    Is Root Cause Analysis done:

    Investigation Team Members

    Name Signature

    Communication done to All users, Inter location : Yes / No

    Receipt of CAPA & Closure : Yes / No

    Verification of Closure by EHS-Incharge Approved by


    Name Name
    Signature Signature
    Date Date
    Doc No :SF- 11 A
    VT LTD
    N REPORT

    Job Code
    Incident No:

    Type Of Injury

    Rest Recommended:

    First Aid Case (FAC)

    gerous Occurrence /Near Miss

    nt :
    Unsafe Condition

    dition

    ared Procedure
    nt:

    rting
    PORT page no:2

    ons Taken

    Target Closing
    Action by Closed by
    Date Date
    Cost of Accident:

    Date

    Approved by Project Incharge


    me
    nature
    e

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