Environmental Engineering Reference
In-Depth Information
AccIdent dAtA, stePPIng or kneelIng on oBject
.(1).What.was.stepped.on?..______________________________________________________________
. . What.was.knelt.on?..________________________________________________________________
.(2).Was.the.stepping.or.kneeling.a.normal.part.of.task.performance?
□
.Yes.
□
.No
.(3).Was.task.being.done.according.to.safe.job.procedures.in.mine?
□
.Yes.
□
.No
. . If.not,.explain:..____________________________________________________________________
.(4).Explain.what.happened.to.victim.after.stepping.or.kneeling.action:.. __________________________
. . . ________________________________________________________________________________
. . . ________________________________________________________________________________
. . . ________________________________________________________________________________
.(5).Have.other.accidents.happened.in.the.same.location.and.in.approximately.the.same.way?
□
.Yes.
□
.No. If.so,.explain:.._______________________________________________________
. . . ________________________________________________________________________________
.(6).Has.victim.had.other.accidents.of.this.kind.not.previously.reported?.. _________________________
□
.Yes.
□
.No. If.yes,.explain:.. ______________________________________________________
. . . ________________________________________________________________________________
.(7).Sketch.position.of.object.and.victim.after.accident.
.(8).Describe.condition.and.construction.of.walkway.or.loor:..__________________________________
.
. . ________________________________________________________________________________
.
. . ________________________________________________________________________________
