Incident Report Muhammad Sohail

SHIFA NATIONAL HOSPITAL, FAISALABAD Initial Incident Report IR
Category: Accident Incident . Near Miss Chemical Spill Fire/Explosion Property Damage
1- Employee Information (to be filled in by Employee and Supervisor)
Name (First, Last). Contractor Name (if applicable). Employee Number. Date of Birth. Gender .
Muhammad Sohail Guarantee Engineers - N/A MALE FEMALE
Location of Incident. Job Title. Khalasi Years of Service with Years on Present Job.
A-Block . Company: N/A
Injury/Illness Summary
Date of Incident. Time.
Witnesses. Zulaqar Ali
27-Aug-22 8:00 PM
Names of Others Involved in Accident: Names of Others Injured in Accident: No
Brief Description of the Event:
During the process of passing of pipe line washing ball after completion of concrete due to pressure a folding pipe hit Muhammad Sohail in the ribs. Fortunately
his did'nt suffer any fracture. After First Aid and Digital X-ray examination he was allowed to work with some light medication.
Supervisor Description and Immediate Corrective Actions:

Informed the concerned area's CM, PM & Client's HSE counterpart
Provided neccassary breifing on safe work practices to the concerned team
Immediate Root Cause:
Negligence of worker.
Mishandling of equipment
Incident Prevention:
Provided necessary breifing prior to start working.
Organized TBT right after the incident and prior to working the next day
Employee Name & Signature Date Supervisor Name & Signature Date
Muhammad Sohail Zulaqar Ali 27-Aug-22 27-Aug-22
2- Type of Incident (to be filled in by Person providing medical assistance)
First Aid Medical Treatment Restricted work Lost Time Injury Fatality Other Near Miss
Nature Part of Body

Amputation Hernia Respiratory Ankle/Leg Face/Nose Groin
Burn Infection Shock Arm/Wrist Finger Lungs
Contusion Laceration / Cut Sprain Back Foot/Toe Rib/Chest
Foreign Body Poisoning Strain, Pull Ear Hand Shoulder/Neck
Fracture Puncture Other___________ Eye Head Other:abdominal
Medical Treatment
Digital X-Ray Examination
Name and Address of Hospital (if hospitalized)

Aziz Fatima Hospital, Faisalabad
Name Doctor/physician/Nurse Signature Date
Prof. Dr Tahir Bashir 27-Aug-22
To be filled in by HSE Department
Detailed Investigation Required: Yes No

Case ID:
HSE Department
SHIFA NATIONAL HOSPITAL, FAISALABAD Initial Incident Report IR
Category: Accident Incident . Near Miss Chemical Spill Fire/Explosion Property Damage
1- Employee Information (to be filled in by Employee and Supervisor)
Name (First, Last). Contractor Name (if applicable). Employee Number. Date of Birth. Gender .
Muhammad Tahir Guarantee Engineers - N/A MALE FEMALE
Location of Incident. Job Title. Carpenter Years of Service with Years on Present Job.
Block C Company: N/A
Injury/Illness Summary
Date of Incident. Time.
Witnesses. Waseem Akram
11-Jun-22 3:30 PM
Names of Others Involved in Accident: Names of Others Injured in Accident: No
Brief Description of the Event:
While shifting plywood in block C unfortunately the worker (M Tahir), the wooden ply slipped and fell on his feet due to which he suffered a minor injury.After
providing initial first aid he was allowed to work on site.
Supervisor Description and Immediate Corrective Actions:

Informed the concerned area's CM, PM & Client's HSE counterpart
Provided neccassary breifing on safe work practices to the concerned team
Immediate Root Cause:
Worker lost consciousness due to extreme weather conditions
Negligence of worker.
Incident Prevention:
Provided necessary breifing prior to start working.
Provided necessary safety equipments
Employee Name & Signature Date Supervisor Name & Signature Date
Muhammad Tahir 11-Jun-22 Waseem Akram 11-Jun-22
2- Type of Incident (to be filled in by Person providing medical assistance)
First Aid Medical Treatment Restricted work Lost Time Injury Fatality Other Near Miss
Nature Part of Body

Amputation Hernia Respiratory Ankle/Leg Face/Nose Groin
Burn Infection Shock Arm/Wrist Finger Lungs
Contusion Laceration / Cut Sprain Back Foot/Toe Rib/Chest
Foreign Body Poisoning Strain, Pull Ear Hand Shoulder/Neck
Fracture Puncture Other___________ Eye Head Other:abdominal
Medical Treatment
Name and Address of Hospital (if hospitalized)
Name Doctor/physician/Nurse Signature Date
To be filled in by HSE Department
Detailed Investigation Required: Yes No

Case ID:
HSE Department
Compatibility Report for Initial incident report IIR.xls
Run on 12/4/2013 11:39
The following features in this workbook are not supported by earlier versions of
Excel. These features may be lost or degraded when opening this workbook in
an earlier version of Excel or if you save this workbook in an earlier file format.
Minor loss of fidelity # of occurrences
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Version
Excel 97-2003

Incident Report Muhammad Sohail

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SHIFA NATIONAL HOSPITAL, FAISALABAD Initial Incident Report IR

Brief Description of the Event:

Supervisor Description and Immediate Corrective Actions:

Nature Part of Body

Name and Address of Hospital (if hospitalized)

To be filled in by HSE Department

Detailed Investigation Required: Yes No

Brief Description of the Event:

Supervisor Description and Immediate Corrective Actions:

Nature Part of Body

Name and Address of Hospital (if hospitalized)

Name Doctor/physician/Nurse Signature Date

To be filled in by HSE Department

Detailed Investigation Required: Yes No

Minor loss of fidelity # of occurrences

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