Environmental Engineering Reference
In-Depth Information
AccIdent dAtA, strIkIng or BumPIng
.(1).What.bumped.or.struck.victim(s)?.. ____________________________________________________
. . What.did.victim(s).bump.or.strike?..____________________________________________________
.(2).Where.was.the.object.or.person.bumped.or.struck.located.relative.to.the.victim(s)?.. _________________
. . . ________________________________________________________________________________
.(3).Was.it.marked?.
□
.Yes.
□
.No. If.yes,.describe:.._______________________________________
. . . ________________________________________________________________________________
.(4).Was.the.lighting.in.the.area.adequate?.
□
.Yes.
□
.No. If.not,.explain:
. . . ________________________________________________________________________________
. . . ________________________________________________________________________________
.(5).What.inlicted.the.injury,.if.any?..______________________________________________________
. . . ________________________________________________________________________________
.(6).Was.victim(s).performing.task.according.to.safe.operating.procedures.of.mine?.
□
.Yes.
□
.No
. . If.not,.explain:..____________________________________________________________________
.(7).Have.other.accidents.happened.in.the.same.location.and.in.approximately.the.same.way?
. .
□
.Yes.
□
.No
. . If.so,.explain:.._____________________________________________________________________
.(8).Has.victim(s).had.other.accidents.of.this.kind,.not.reported.previously?
□
.Yes.
□
.No.
If.so,.explain:.._______________________________________________________
.
. . ________________________________________________________________________________
