Environmental Engineering Reference
In-Depth Information
AccIdent dAtA, hAndlIng mAterIAl
.(1).Material.being.handled:.._____________________________________________________________
.(2).Material:._________.Loose. _________.Bagged. _________.Boxed. _________.Solid.Item
.(3).Weight:._________.lb. Length:._________.in.. Width:._________.in.. Height:._________.in.
.(4).Activity.at.time.of.accident.(describe.purpose.of.action,.distance.material.to.be.removed,.etc.):.
. . . ________________________________________________________________________________
. . . ________________________________________________________________________________
.(5).Was.activity.a.normal.requirement.of.the.job?.
□
.Yes.
□
.
No.
If.so,.was.activity.being.done.as.
trained?.
□
.Yes.
□
.No
.
. According.to.company.safe.job.procedures?.
□
.Yes.
□
.No.
If.not.as.trained,.nor.according.to.
safe.job.procedures,.explain.how.and.why:
. . . ________________________________________________________________________________
. . . ________________________________________________________________________________
.(6).Tool.or.aid.used?.
□
.Yes.
□
.No. If.used,.describe:.._____________________________________
. . Was.tool.or.aid.used.correctly?.
□
.Yes.
□
.No. If.not,.explain:
. . . ________________________________________________________________________________
. . . ________________________________________________________________________________
. . . ________________________________________________________________________________
.(7).Action:._________.Lifting. _________.Pulling. _________.Pushing. _________.Carrying
. . _________.Shoveling. _________.Other.(describe):..________________________________________
.(8).Injury.resulted.from:._________.Improper.lifting,.pulling,.or.pushing.
_________.Dropped.material.
_________.Overload.
_________.Pinching.
_________.Other.(describe):
.
. . ________________________________________________________________________________
.
. . ________________________________________________________________________________
.
. . ________________________________________________________________________________
.
.
________________________________________________________________________________
