Page 1 of 5 NASS SCAFFORM CONTRACTING
Revision: ACCIDENT / INCIDENT INVESTIGATION REPORT
Report#:
Date of 18-03-2024 Time of Incident: 0230:PM
Incident
Site: Bapco wharf Location of Incident Near security Gate
Type of Incident: (place X )
LTI NLTI First Aid Case Restricted Work Near Miss Fire
Case
Fatality Environmental Releases Incident Heat Illness Other
If other give details:
Task Being Conducted: (place X )
Scaffold E and D Manual Handling FLT Operation Maintenance Driving
Loading/Unload Employee Movement Office Work Inspection Other
If other give details:
Injured Party/Person Involved: Badge # Position: Nationality: Years of Experience:
7036 Driver Pakistani 10 years
Details of Injury: Injury Caused by:
18-Mar-24
Details of Damage: Damage Caused by:
Coaster right back side scratch Amjad iqbal
Witness: Badge #:
Gangadhar marri 81274
Details of how the Event Occurred:
On 18 –Mar-2024 Monday around 02:30 PM. Mr Amjad Iqbal Badge # 7036 Coaster bus driver was returned from Wharf T-Head
Dropping the passengers. While he reached to security gate his bus was unexpectedly slightly hit to the pickup which was parked
in the parking area, Resulted minor scratch on the both vehicles. No injuries were reported.
.
Immediate Cause: (place X )
Unsafe Act Unauthorised use of Failure to use safety Operating at improper speed Under the influence
equipment device of substance
Failure to secure Improper handling Failure to warn Incorrect use of equipment. Improper placement
Horseplay Improper loading Tampering with safety Failure to follow procedures Failure to use PPE
equipment. or SSOW properly
Servicing equipment Using defective tools Failure to Identify Failure to check/monitor Failure to
which is in operation or equipment Hazard/Risk Communicate
Failure to React/Correct Other:
Unsafe Condition Improper PPE Poor Housekeeping Defective tools/equipment Fire/explosion
Improper barricade or Hazardous Improper position for Inadequate warning system Congestion or
guards environment task restricted action
Inadequate lighting Noise exposure Temperature Inadequate ventilation Other:
Chance Occurrence Detail:
Ser Corrective Action: Responsible by Date Date Completed
Person
1 TBT was conducted to driver and explained safe driving . SUP / HSE 18-03-2024 18-03-2024
2 |Ensure all driver should follow the Bahrain driving rules SUP / HSE always Ongoing
Report Completed by: Signed: Position: Date Completed
GANGADHAR MARRI HSE OFFICER 18-03-2024
Review of the above recommendations by management representative:
Are the above corrective and preventative actions deemed adequate? Yes No
If NO what other corrective and preventative actions are required Person By Date CompletedDate
Issue No.: 02 Date of Issue: 2nd November 2017 Form No: N-QHSE-FRM-313
Page 2 of 5 NASS SCAFFORM CONTRACTING
Revision: ACCIDENT / INCIDENT INVESTIGATION REPORT
Report#:
Responsible
1
2
3
Further Comments:
Name: Signed: Position: Date:
Forward ASAP to HSE Manager
Comments by HSE Manager:
Is an Investigating committee required? If yes complete form N-QHSE-FRM-311 (Investigation Committee
Report). Yes No
Comments:
Ser Corrective Action: Responsible By Date Date Completed
Person
1
Name: Signed: Position: Date:
Closed out by HSE Manager:
Number of days if LTI Effectiveness of corrective and preventative actions confirmed? Yes No
Comments:
Name: Signed: Position: Date Closed:
Issue No.: 02 Date of Issue: 2nd November 2017 Form No: N-QHSE-FRM-313
Page 3 of 5 NASS SCAFFORM CONTRACTING
Revision: ACCIDENT / INCIDENT INVESTIGATION REPORT
Report#:
Witness Statement (attach additional forms as required)
Name Badge # Position: Nationality: Years of Experience:
[Link] IQBAL 7036 DRIVER PAKISTANI 10
MEDICAL REPORT
Issue No.: 02 Date of Issue: 2nd November 2017 Form No: N-QHSE-FRM-313
Page 4 of 5 NASS SCAFFORM CONTRACTING
Revision: ACCIDENT / INCIDENT INVESTIGATION REPORT
Report#:
TBT
Issue No.: 02 Date of Issue: 2nd November 2017 Form No: N-QHSE-FRM-313
Page 5 of 5 NASS SCAFFORM CONTRACTING
Revision: ACCIDENT / INCIDENT INVESTIGATION REPORT
Report#:
Issue No.: 02 Date of Issue: 2nd November 2017 Form No: N-QHSE-FRM-313
