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Victim and Witness statement

Mr. Md Meeraj Ansari, an Electrical Helper, sustained a minor cut on his left forearm while performing cable termination work on 30/11/2024. The injury occurred when he slipped while holding a knife, and he promptly reported it to the site first aider for treatment. A witness, Pothiraj Ramasubbu, confirmed the incident and the actions taken following the injury.

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Victim and Witness statement

Mr. Md Meeraj Ansari, an Electrical Helper, sustained a minor cut on his left forearm while performing cable termination work on 30/11/2024. The injury occurred when he slipped while holding a knife, and he promptly reported it to the site first aider for treatment. A witness, Pothiraj Ramasubbu, confirmed the incident and the actions taken following the injury.

Uploaded by

harsha thor
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Injured Person Statement

Name: Mr. Md Meeraj Ansari


Position & ID: Electrical Helper & 15003939
Date of Incident and time: 30/11/2024 & 04.00 PM
Location of Incident: BESS/ Switch yard
Type of Injury: Minor Cut on Left Forearm
Date started Work: 30/11/2024

I, Mr. Md Meeraj Ansari, started work at 7.30 am and attended PTST conducted by Mr.Pothiraj
RamaSubbu, Chargehand -Electrical at (7am ). I was engaged in the electrical cable termination
activity at the site. While holding a knife in my right hand, I attempted to pull back the cable sleeves
toward myself. Unfortunately, my hand slipped, and the knife touched my left-hand forearm.

This caused a small cut on my left forearm. I quickly reported it to the site first aider, and he took me
to the clinic, where I was given treatment, and I returned to work.

I was wearing my full PPE and wearing coverall but pulled up my sleeve as I was feeling warm. I am
aware that during work I cannot pull up my sleeves as this could have prevented the injury.

Statement recorded by Ashok Kumar (EHS Assistant Manager) in English and translated in Hindi to
Mr. Meeraj.

Signature of IP: __________________ Recorder:

Date: __________________

Sensitivity: LNT Construction Internal Use


Name of Witness: Pothiraj Ramasubbu
Position & ID : Chargehand -Electrical & 15003814
Date of Incident & Time : 30/12/2024 & 04.00PM
Location of Incident: [Bess / Switch yard]

I, Pothiraj Ramasubbu, was present at the site during the incident involving Mr. Md Meeraj Ansari. I
observed that Mr. Meeraj was engaged in cable electrical termination activity. While holding a knife
in his right hand, he attempted to pull back the cable sleeves toward himself. Unfortunately, his hand
slipped, and the knife contacted his left-hand forearm.

This resulted in a small cut on his left forearm. Mr. Ansari immediately reported the incident to the
site first aider, who then took him to the clinic, where treatment was provided.

Signature of Witnesses: __________________

Date: __________________

Sensitivity: LNT Construction Internal Use

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