Incident&;accident report date 02.08.2014 by arber dogani example for aplications

1. Project
Accident - Incident Report
Transmission Line Works
1 | P a g e
Type of
incident
Personnel injury
Work related
illness
Material damage
Security breach
Accidental pollution
Motor vehicle
accident
Fire / explosion
Community relations
incident
Near miss
 Other:
Environmental
Incident.
Time and
place
Location: Moglica Road Lot2 Km from 18+544 to 23+300
Date
02.03.2014
Time
12:00PM
□ During working hours
□ During business travel
□ During leisure time
Organisational unit:
Truck’s Team
Employee
Info.
Employee no. Name:
Date of birth
11.10.1991
Occupation / position
Truck Driver
Company/Department / Employer
Company
Description
of incident /
events /
illness
Main activity at the time of the event?
Excavator was charged on the tugboat.
How did the incident occur?
When the legs oftugboat was closed the hydraulic pump of tugboat legs is broken and the
hydraulic oil was spilled on the asphalt. The spilled hydraulic oil was somewhere to 4 or 5
Litres.
Machinery, tools, chemicals or materials involved?
None
Injury or
damage
info.
Describe injury / damage / type of
illness
Lost-time injury
Restricted work case injury
Medical treatment injury
Other incl. first aid injury
Emergency preparedness
organisation mobilised
Eyes
Head, face
Back
Trunk
Arm
Hand, wrist
Leg
Feet, ankles
Internal
Other
Amputation
Burn, scald
Concussion
Crushing
Cut, puncture
Fracture
Hernia
Bruise
Sprain, strain
Other
Deviations Equipment Inspections was not made at right time.
Causal
analysis
The pulley of the hydraulic oils was deadlocked and consequently oil pressure wasdamaged
the counter valve.
Actions
taken
1.The truck Driver was close all the hydraulic pipelines to avoid as little oil leaking.
Actions to prevent recurrence:
We send the Tugboat to Mechanical Departament
and they repaired all the leaks problem at this
truck.
Responsible
Eng.
Due date
03.08.2014

2. Project
Accident - Incident Report
Transmission Line Works
2 | P a g e
Signatures Date
08.08.2014
Resp. Supervisor Date
08.08.2014
Reported by
Arber Dogani
Where applicable has the relevant regulatory authority been informed? Yes
DHP Observation Corrective Actions Taken
Comments: Oil Of New Asphalt Surfacing on Lot 2 road 1 Comments: For emergency we clean the asphalt only
with water because is very difficult to find oil
washing products for asphalt in a Albania, but we
assure you that next month during September we have
order to buy abroad ( Oil Spill Clean Up for
Concrete, Asphalt, Soil to protect the
Environment.)