Truck 137 Hit Truck 48
Content
Details needed to enter a report into synergi web application Note:the fields that are marked in green are mandatory Case Type Incident Title Date Of Incident Time (24 hrs clock) Port /CIS Location Vessel/Site
Near Miss Truck 137 hit Truck 48 7/10/2014 23:15:00 PM Port Said Under QC12
Vessel/Site(If other please specify) Detailed Location Shipping Line Master/Supervisor at time of incident Operating Office Reported By Name Of Company, if 3rd party Incident Description (with details)
Under QC12 Truck driver OPS TSV
While Truck 137 enter under QC12 for loading hit truck 48 which lead to hit truck 56 and making damage in Truck 48 bumper and minor scratch in both tail.
Equipment involved Equipment number 1- inform Safety Supervisor. 2- informed Eng team.
immediate action taken weather condition road condition visibility suggestion for improvement Injured persons details Employee number National ID First Name Surname Home address
Clear Dry Good
Phone TWIC No./ID No. Work address Social Security Number Date Of Birth Gender age Employment category company Unit/Department 3rd party type job title marital status Involved Person/Witness details(if any) Employment Category first Name Surname Person Involved as Telephone Number Job Title Social Security Number Home/work Address If Over the road driver, drivers license no. and state
gi web application
Actual event type A.]People B.]Asset damaged C.]Environment D.]Reputation
A.]People (If any) Accident category Course of events Detailed course of events Type of injury Part of body harmed Estimated workdays lost Actual workdays lost Estimated workdays restricted Actual workdays restricted Is The container able to move out via vessel/rail/chassis Does The container need M&R to take action
Department Explain Damage Damage caused by Pre-existing damage Forpre-existing damage,(if cargo/container) eter the ship name/gate number/date/cargo type. Must track repair expenses.
Operating office in charge of case Person in charge
Loss Potential
Potential Event type People Asset Environment Reputation Most probable recurrence frequency
Contractor Customer Employee Full-time employee Government Authorities Hired Others(Please Specify) Over the road/external driver Port employee Shipping Line/Vessel crew Substitute Vendor Visitor Involved Witness
Clear Fog Ice/Snow NA Overcast Rain Sun Thunder storm Windy
CHE 1.Chassis/Trailer 2.Empty Handler 3.Mobile Crane 4.Rail-Mounted Gantry(RMG) 5.Reach Stacker 6.Rubber-Tired Gantry(RTG) 7.Ship Crane 8.Ship-To-Shore-Crane 9.Shuttle Carrier 10.Straddle Carrier 11.Terminal Tractor 12.Top Loader CONTAINER 1.Dry 2.Flat rack
3.Open Top 4.Reefer 5.Tank MISCELLANEOUS 1.Building/Facility 2.Cargo 3.Chassis Flipper 4.Lashing Gear 5.Leakage Trailer 6.Others(please specify) 7.Over Height Frame 8.Rail Chassis 9.Safety/Lashing Cage 10.Spreader 11.Tug/Boat 12.Vessel VEHICLE 1.3rd party vehicle 2.Bus 3.Car 4.Emergency Vehicle 5.Fork Lift 6.Fuel Truck 7.Man Lift 8.Pick up 9.Sweeper.
No Yes Undetermined Cargo Chassis Container No Yes Observation Near Miss Incident
slip/trip/fall squeezed struck against struck by struck down by
Building Dock/Quay Gate Inspection Area/CFS Off-Site Other(Please Specify) Parking Rail
APL CMA CGM COSCO CSAV China Shipping(CSCL) Eimskip Evergreen Marine Corp Hamburg Sud
Vessel Warehouse Workshop(M&R) Yard
Hanjin Hapag Lloyd Horizon Lines Hyundai(HMM) Item2 K-Line MSC Maersk Mol_group NYK OOCL Others(Pl Specify) PIL Shandong UASC Wanhai Yang Ming ZIM
Dry Flooded Ice/Snow Muddy NA Oil/Grease Sandy Uneven wet
AOM/Shift Manager/Ops Clerk/Checker Driver:3rd Party Driver: Company Vehicle(Bus,Car,Pickup,Motorbike) Driver: Container Handling Equipment Driver: Forklift Driver:UTR/Terminal Tractor Flagman/Signalman/Wharf Controller Foreman/Supervisor Gearman/Lasher(Vessel) Line Handler/Mooring Crew MESC Mechanic/Engineer/Technician OCU Others-3rd party(please specify) Others-Employees(please specify)
Allergic reaction Asbestosis Cancer Cardio logical Contagious Disease Cumulative trauma Diseases caused by biological agents Diseases caused by chemical agents Diseases caused by physical agents Hearing loss Heat Prostration/Heat stroke Mental stress Non Occupational Not selected 1.Poisoning
Pinman/Coneman/Lasher(Quayside) Security White Collar
2.Radiation 3.Respiratory 4.Silicosis
Abdomen/stomach Ankle Back/spine Buttock/hip/groin Chest Ear Elbow Ear Eye Face/head Hand/wrist Knee Left arm Left foot Leg Lower arm Mental/emotional Neck Nose Right arm Right foot Shoulder Skull Throat Thumb Toe/nail Upper arm Whole body Finger Forehead Others (please specify)
Abrasion/Bruise/Contusion Amutation Burn Burn/Scald Cardiac/respiratory Concussion Contusion/Bruising/contact skin Crushing Cut/Open wound Cut/Laceration/scratched/punctured Damage caused by electricity Dislocation Electric shock Emotional Stress Exposure Fatal Foreign body in wound Foreign object Invasion Facture Fracture/sprain Hernia Illness Injury to internal organ Internal ache/pain Jostling Multiple injuries Muscle Strain Pass-out Poisoning Reaction to Chemical Skin Irritation Smash/Trauma Soft Tissue Injury Sprain Stress Superficial Injury Swelling Traumatic Amputation Twist/Bend Unknown
Overstrain/exertion Caught in/by/between Caught up in Contact with Contact with(elec./temp./col/etc) Fall to lower level Fall to same level Foreign object in eye Hit against
Jostled/shock by Other(Please Specify) Pressure related slip/trip/fall squeezed struck against struck by struck down by
Good NA Poor Satisfactory Very good Very Poor
Man Woman
divorced domestic partner living together married registered partners separated single unknown widowed
Building Container handeling Equipment Container repair & maintenance Dock/Quay Gate Inspection Area/CFS Non- Containerised Cargo Off - Site Other Inland Services operations(Ware house,CFS..etc) Other Terminal Ops Labour Parking Rail Reefer handeling Transport Truck/tractor driver Vessel Warehouse Workshop (M & R) Yard
Contractor Customer Government Authorities Others(Please Specify) Over the road/external driver Port employee Shipping Line/Vessel crew Vendor Multiple fatalities single fatality LTI Days away from work Restricted work Medical treatment only first aid only
yes no
Other type of fire
5.Multiple Fatalities-resulting from injury or occupational health 4.Single Fatality or permanent total disability 3.Major injury or health impact-affecting work performance for more than 5 days 2.Minor injury or health impact-affecting work performance upto 5 days 1.Slight injury/health impact-not affecting work performance/daily life activity
5.More than 1.0 milloion USD 4.Between 100,000 USD and 10,00,000 USD 3.Between 10,000 USD and 100,000 USD 2.Between 1,000 USD and 10,000 USD 1.Lower than 1,000 USD
Electrical fire Fire in solid materials Fluid fire Hydrocarbon fire Metal Fire
others(Please Specify) Auto Sprinkler dry pipe Auto Sprinkler-wet pipe Dry Chemicals Fire water monitors Fire Truck Foam system Halon Release Hand extinguisher Overpressure/ventilation fans Permanent CO2 system Shutdown Smoke and Fire doors Water Water mist Water spray-AFFF water wall Others(Please Specify) 3rd party Terminal
A.Never heard in industry B.Heard of in industry but not heard of in APMT C.Has happened more than once in the indusrty or has happened at the location D.Has happened more than once in APMT or has happened at the location E.Has happened more than once at the location 5.Massive impact-Persistent,severe environmental damage 4.Major impact-Severe environmental damage that requires extensive measures. 3.Moderate impact-limited env damage that persists and requires cleaning up 2.Minor impact-minor environmental effect but no lasting damage 1.Slight impact-slight env damage that contains within the premise
5.Massive impact-on APMT reputation,-Govt/International public/NGO concern 4.Major impact-Likely to escalate and affectAPMT reputaion 3.Moderate impact-significant impact in country.local stkhldrs are concerned 2.Minor impact-Local public concern or local media coverage 1.Slight impact-local public awareness but no discernable concern/media coverage
ational health
ormance for more than 5 days formance upto 5 days rformance/daily life activity
has happened at the location appened at the location
t requires extensive measures. ts and requires cleaning up lasting damage hin the premise
national public/NGO concern
cal stkhldrs are concerned
rnable concern/media coverage
Near Miss Truck 137 hit Truck 48 7/10/2014 23:15:00 PM Port Said Under QC12
Vessel/Site(If other please specify) Detailed Location Shipping Line Master/Supervisor at time of incident Operating Office Reported By Name Of Company, if 3rd party Incident Description (with details)
Under QC12 Truck driver OPS TSV
While Truck 137 enter under QC12 for loading hit truck 48 which lead to hit truck 56 and making damage in Truck 48 bumper and minor scratch in both tail.
Equipment involved Equipment number 1- inform Safety Supervisor. 2- informed Eng team.
immediate action taken weather condition road condition visibility suggestion for improvement Injured persons details Employee number National ID First Name Surname Home address
Clear Dry Good
Phone TWIC No./ID No. Work address Social Security Number Date Of Birth Gender age Employment category company Unit/Department 3rd party type job title marital status Involved Person/Witness details(if any) Employment Category first Name Surname Person Involved as Telephone Number Job Title Social Security Number Home/work Address If Over the road driver, drivers license no. and state
gi web application
Actual event type A.]People B.]Asset damaged C.]Environment D.]Reputation
A.]People (If any) Accident category Course of events Detailed course of events Type of injury Part of body harmed Estimated workdays lost Actual workdays lost Estimated workdays restricted Actual workdays restricted Is The container able to move out via vessel/rail/chassis Does The container need M&R to take action
Department Explain Damage Damage caused by Pre-existing damage Forpre-existing damage,(if cargo/container) eter the ship name/gate number/date/cargo type. Must track repair expenses.
Operating office in charge of case Person in charge
Loss Potential
Potential Event type People Asset Environment Reputation Most probable recurrence frequency
Contractor Customer Employee Full-time employee Government Authorities Hired Others(Please Specify) Over the road/external driver Port employee Shipping Line/Vessel crew Substitute Vendor Visitor Involved Witness
Clear Fog Ice/Snow NA Overcast Rain Sun Thunder storm Windy
CHE 1.Chassis/Trailer 2.Empty Handler 3.Mobile Crane 4.Rail-Mounted Gantry(RMG) 5.Reach Stacker 6.Rubber-Tired Gantry(RTG) 7.Ship Crane 8.Ship-To-Shore-Crane 9.Shuttle Carrier 10.Straddle Carrier 11.Terminal Tractor 12.Top Loader CONTAINER 1.Dry 2.Flat rack
3.Open Top 4.Reefer 5.Tank MISCELLANEOUS 1.Building/Facility 2.Cargo 3.Chassis Flipper 4.Lashing Gear 5.Leakage Trailer 6.Others(please specify) 7.Over Height Frame 8.Rail Chassis 9.Safety/Lashing Cage 10.Spreader 11.Tug/Boat 12.Vessel VEHICLE 1.3rd party vehicle 2.Bus 3.Car 4.Emergency Vehicle 5.Fork Lift 6.Fuel Truck 7.Man Lift 8.Pick up 9.Sweeper.
No Yes Undetermined Cargo Chassis Container No Yes Observation Near Miss Incident
slip/trip/fall squeezed struck against struck by struck down by
Building Dock/Quay Gate Inspection Area/CFS Off-Site Other(Please Specify) Parking Rail
APL CMA CGM COSCO CSAV China Shipping(CSCL) Eimskip Evergreen Marine Corp Hamburg Sud
Vessel Warehouse Workshop(M&R) Yard
Hanjin Hapag Lloyd Horizon Lines Hyundai(HMM) Item2 K-Line MSC Maersk Mol_group NYK OOCL Others(Pl Specify) PIL Shandong UASC Wanhai Yang Ming ZIM
Dry Flooded Ice/Snow Muddy NA Oil/Grease Sandy Uneven wet
AOM/Shift Manager/Ops Clerk/Checker Driver:3rd Party Driver: Company Vehicle(Bus,Car,Pickup,Motorbike) Driver: Container Handling Equipment Driver: Forklift Driver:UTR/Terminal Tractor Flagman/Signalman/Wharf Controller Foreman/Supervisor Gearman/Lasher(Vessel) Line Handler/Mooring Crew MESC Mechanic/Engineer/Technician OCU Others-3rd party(please specify) Others-Employees(please specify)
Allergic reaction Asbestosis Cancer Cardio logical Contagious Disease Cumulative trauma Diseases caused by biological agents Diseases caused by chemical agents Diseases caused by physical agents Hearing loss Heat Prostration/Heat stroke Mental stress Non Occupational Not selected 1.Poisoning
Pinman/Coneman/Lasher(Quayside) Security White Collar
2.Radiation 3.Respiratory 4.Silicosis
Abdomen/stomach Ankle Back/spine Buttock/hip/groin Chest Ear Elbow Ear Eye Face/head Hand/wrist Knee Left arm Left foot Leg Lower arm Mental/emotional Neck Nose Right arm Right foot Shoulder Skull Throat Thumb Toe/nail Upper arm Whole body Finger Forehead Others (please specify)
Abrasion/Bruise/Contusion Amutation Burn Burn/Scald Cardiac/respiratory Concussion Contusion/Bruising/contact skin Crushing Cut/Open wound Cut/Laceration/scratched/punctured Damage caused by electricity Dislocation Electric shock Emotional Stress Exposure Fatal Foreign body in wound Foreign object Invasion Facture Fracture/sprain Hernia Illness Injury to internal organ Internal ache/pain Jostling Multiple injuries Muscle Strain Pass-out Poisoning Reaction to Chemical Skin Irritation Smash/Trauma Soft Tissue Injury Sprain Stress Superficial Injury Swelling Traumatic Amputation Twist/Bend Unknown
Overstrain/exertion Caught in/by/between Caught up in Contact with Contact with(elec./temp./col/etc) Fall to lower level Fall to same level Foreign object in eye Hit against
Jostled/shock by Other(Please Specify) Pressure related slip/trip/fall squeezed struck against struck by struck down by
Good NA Poor Satisfactory Very good Very Poor
Man Woman
divorced domestic partner living together married registered partners separated single unknown widowed
Building Container handeling Equipment Container repair & maintenance Dock/Quay Gate Inspection Area/CFS Non- Containerised Cargo Off - Site Other Inland Services operations(Ware house,CFS..etc) Other Terminal Ops Labour Parking Rail Reefer handeling Transport Truck/tractor driver Vessel Warehouse Workshop (M & R) Yard
Contractor Customer Government Authorities Others(Please Specify) Over the road/external driver Port employee Shipping Line/Vessel crew Vendor Multiple fatalities single fatality LTI Days away from work Restricted work Medical treatment only first aid only
yes no
Other type of fire
5.Multiple Fatalities-resulting from injury or occupational health 4.Single Fatality or permanent total disability 3.Major injury or health impact-affecting work performance for more than 5 days 2.Minor injury or health impact-affecting work performance upto 5 days 1.Slight injury/health impact-not affecting work performance/daily life activity
5.More than 1.0 milloion USD 4.Between 100,000 USD and 10,00,000 USD 3.Between 10,000 USD and 100,000 USD 2.Between 1,000 USD and 10,000 USD 1.Lower than 1,000 USD
Electrical fire Fire in solid materials Fluid fire Hydrocarbon fire Metal Fire
others(Please Specify) Auto Sprinkler dry pipe Auto Sprinkler-wet pipe Dry Chemicals Fire water monitors Fire Truck Foam system Halon Release Hand extinguisher Overpressure/ventilation fans Permanent CO2 system Shutdown Smoke and Fire doors Water Water mist Water spray-AFFF water wall Others(Please Specify) 3rd party Terminal
A.Never heard in industry B.Heard of in industry but not heard of in APMT C.Has happened more than once in the indusrty or has happened at the location D.Has happened more than once in APMT or has happened at the location E.Has happened more than once at the location 5.Massive impact-Persistent,severe environmental damage 4.Major impact-Severe environmental damage that requires extensive measures. 3.Moderate impact-limited env damage that persists and requires cleaning up 2.Minor impact-minor environmental effect but no lasting damage 1.Slight impact-slight env damage that contains within the premise
5.Massive impact-on APMT reputation,-Govt/International public/NGO concern 4.Major impact-Likely to escalate and affectAPMT reputaion 3.Moderate impact-significant impact in country.local stkhldrs are concerned 2.Minor impact-Local public concern or local media coverage 1.Slight impact-local public awareness but no discernable concern/media coverage
ational health
ormance for more than 5 days formance upto 5 days rformance/daily life activity
has happened at the location appened at the location
t requires extensive measures. ts and requires cleaning up lasting damage hin the premise
national public/NGO concern
cal stkhldrs are concerned
rnable concern/media coverage
