Worksafe Incident Report

I. Incident Overview

Report Number: IR-2050-002
Date of Report: May 19, 2050
Time of Report: 2:00 PM
Reported By: [Your Name]
Position: Senior Safety Officer
Incident Date: May 18, 2050
Incident Time: 11:15 AM
Location of Incident: Production Floor, Line 3

II. Description of Incident

Type of Incident: Near Miss

At approximately 11:15 AM, a forklift driven by Mark Thompson nearly collided with a pallet of materials left in the walkway on the Production Floor, Line 3. The forklift operator managed to stop just in time, preventing potential injury and damage. The pallet had been left unattended by the loading crew, which created a hazardous obstruction in the designated walkway. Samantha Lee and Tom Hanks, who were working nearby, witnessed the incident.

III. People Involved

Role	Name	Position	Contact Information
Forklift Operator	Mark Thompson	Forklift Operator	[email protected]/(555) 321-9876
Loading Crew Member/Witness	Sarah Johnson	Loading Crew Member	[email protected]/(555) 876-5432
Witness	Tom Hanks	Inventory Checker	[email protected]/(555) 987-6543

IV. Witness Statements

A. Witness 1

Name: Samantha Lee
Contact Information: [email protected] / (555) 234-5678
Statement:
"I was stacking boxes nearby when I saw Mark's forklift coming down the aisle. It was going pretty fast, and then I noticed the pallet blocking his path. I thought they were going to collide, but Mark managed to stop just in time. It was a close call."

B. Witness 2

Name: Tom Hanks
Contact Information: [email protected] / (555) 987-6543
Statement:
"I was doing inventory checks when I heard the forklift approaching. I saw the pallet in the walkway and thought, 'Uh oh, this isn't good.' Thankfully, Mark was able to stop in time. It could have been a serious accident if he hadn't reacted quickly."

IV. Injuries/Damage

A. Injuries

No injuries were reported.

B. Damage

No property or equipment damage occurred.

V. Immediate Actions Taken

The walkway was immediately cleared of the obstructing pallet. A brief safety meeting was held with the loading crew to emphasize the importance of keeping walkways clear and adhering to proper material storage protocols.

VI. Root Cause Analysis

A. Preliminary Findings

The near miss was caused by the loading crew’s failure to follow established procedures for storing materials. The crew left the pallet in an area designated as a walkway, creating a significant safety hazard.

B. Follow-Up Actions

A detailed review of the loading crew's procedures and adherence to safety protocols will be conducted. Additional training sessions will be scheduled to ensure all team members understand and follow the correct procedures.

VII. Corrective Actions

A. Short-Term Corrective Actions

An immediate re-training session on material storage and walkway clearance has been conducted for the loading crew. Visual reminders and signs have been placed in critical areas to reinforce the importance of keeping walkways clear.

B. Long-Term Preventive Measures

A new policy has been implemented requiring regular checks of all walkways to ensure they are free from obstructions. Monthly safety drills and inspections will be conducted to maintain high safety standards and compliance with protocols.

VIII. Conclusion and Recommendations

The near-miss incident was a result of non-compliance with material storage procedures. It is recommended that ongoing training and periodic audits be enforced to maintain safety standards. Enhanced communication between departments regarding the importance of workplace safety should also be promoted.

IX. Company Information

Company Name: [Your Company Name]
Company Address: [Your Company Address]
Company Email: [Your Company Email]
Company Phone Number: [Your Company Number]
Company Website: [Your Company Website]
Company Social Media: [Your Company Social Media]