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IL I <br /> -01 n1"1011 <br /> INCIDENT, NEAR MISS AN6 LOSS REPORT <br /> HSE 1 AUTO 1 P <br /> � ROPERTY) <br /> Stan <br /> TABLE 1 -Type of Contact <br /> Type of Contact <br /> Contact With I� <br /> 1. Struck against ' <br /> 2. Struck b 1. ElectricityL ' <br /> y <br /> 3. Caught in �� <br /> 2. Heat y3' <br /> 4. Caught on 3. Cold4. Radiation <br /> 5. Caught between 5. Caustics <br /> 6. Slip <br /> • 6. Noise ! 41 <br /> 7. Fall on same level 7. :Toxic or,Noxious substances <br /> 8. Fall to lower level <br /> 9. Overexertion <br /> 10. Sprains and Strains <br /> 11. Repetitive Motion ; <br /> 12. Animal attack <br /> L 13. Other <br /> TABLE 2-Immediate Causes <br /> j Substandard Actions: <br /> Substandard Conditions <br /> 1. Operating Equipment without authority 1: Inadequate or ii'nproper protective equipment <br /> 2. Failure to Warn 2. Defective tool s;'equipment or materials <br /> 3. Failure to Secure 3. Restricted Action <br /> 4- Operating at improper speed 4. Inadequate warning systems <br /> 5. Making safety devices inoperable 5. Fire and.'-explosion hazard <br /> 6. Removing safety devices 6. Poor Housekeeping <br /> 7. Using defective Equipment 7. Hazardous environmental conditions; gases, <br /> 8. Using equipment improperly dusts, fumes, smoke, vapors <br /> 9. Failing to use personal protective equipment 8. Noise Exposure <br /> �4properly 9. High or low temperature exposure <br /> 10. Improper loading 10. Inadequate or excess illumination <br /> 11. Improper placement 11. Inadequate ventilation <br /> F 12. Improper lifting 12. ExtemakFactors <br /> 13. Improper Position for task js <br /> 14. Servicing equipment in operation <br /> 15. Horseplay <br /> 16. Under influence of alcohol and/or drugs. <br /> TABLE 3- Underlying Causes <br /> Personal Factors Job Factors <br /> 1. Inadequate capability 1. Inadequate leadership/supervision <br /> 2. Lack of knowledge 2. Inadequate engineering <br /> 3. Lack of skill 3. Inadequate purchasing <br /> 4. Stress 4. Inadequate maintenance <br /> 5. Improper Motivation 5. Inadequate tool slequipmentlmaterials <br /> 6. Inadequate work standards <br /> 7. Wear and tear <br /> 8. Abuse and misuse <br /> L <br /> HSE-620 Incident, Near Miss&Loss Reporl Rev. 10-08 Page 6 of 6 <br /> "i <br /> 1 <br />