Anda di halaman 1dari 5

Injured Person


I. Following Procedures
a. Violation by Individual
b. Violation by group
c. Violation by supervisor
d. Operation of Equipment without authority
e. Improper position or posture for the task
f. Overexertion of physical capability
g. Work or motion at improper speed
h. Improper lifting techniques
i. Improper loading
j. Shortcuts
II. Use of Tools or Equipment
a. Improper use of equipment
b. Improper use of tools
c. Use of defective equipment (Aware)
d. Use of defective tools (Aware)
e. Improper placement of tool, equipment, or materials
f. Operation of equipment at improper speed
g. Servicing of equipment in operation
III. Use of Protective Methods
a. Lack of knowledge of hazard present
b. PPE not used
c. Improper use of PPE
d. Servicing of energized equipment
e. Equipment or materials not secured
f. Disabled guards, warning systems or safety devices
g. Removal of guards, warning systems or safety devices
h. PPE not available
IV. Inattention / Lack of Awareness
a. Improper decision making or lack of sound judgement
b. Distracted by other concerns
c. Inattention to footing and surroundings
d. Horseplay
e. Acts of violence
f. Failure to warn
g. Use of drugs or alcohol
h. Routine activity without thought

I. Protective System
a. Inadequate guards or protective devices
b. Defective guards or protective devices
c. Inadequate PPE
d. Defective PPE
e. Inadequate warning systems
f. Defective warning systems
g. Inadequate isolation of process or equipment
h. Inadequate safety devices
i. Defective safety devices
II. Tools, Equipment, and Vehicles
a. Defective Equipment
b. Inadequate equipment
c. Improperly prepared equipment
d. Defective Tools
e. Inadequate Tools
f. Improperly prepared tools
g. Defective Vehicle
h. Inadequate vehicle for the purpose
III. Work Exposures to:
a. Fire or Explosion
b. Noise
c. Energized electrical systems
d. Energized systems, other than electrical
e. Radiation
f. Temperature extremes
g. Hazardous Chemicals
h. Clutter or debris
i. Storms or acts of nature
j. Slippery floors or walkways
IV. Work Place Environment / Layout
a. Congestion or restricted motion
b. Inadequate or excessive illumination
c. Inadequate ventilation
d. Unprotected height
e. Inadequate workplace layout
Controls less than adequate
Displays less than adequate
Labels less than adequate
Locations out of reach or sight
Conflicting information is presented

I. Physical Capability
a. Vision deficiency
b. Hearing deficiency
c. Other sensory deficiency
d. Reduced respiratory capacity
e. Other permanent physical disabilities
f. Temporary disabilities
g. Inability to sustain body positions
h. Restricted range of body movement
i. Substance sensitivities or allergies
j. Inadequate size or strength
k. Diminished capacity/capability due to medication
II. Physical Condition
a. Previous injury or illness
b. Fatigue due to:
Lack of rest
Sensory overload
c. Diminished performance
Temperature extremes
Oxygen deficiency
Atmospheric pressure variation
d. Blood sugar insufficiency
e. Impairment due to drug or alcohol use
III. Mental Status
a. Poor Judgement
b. Memory Failure
c. Poor Coordination or reaction time
d. Emotional disturbance
e. Fears or Phobias
f. Low mechanical aptitude
g. Low learning aptitude
h. Influenced by medication
IV. Mental Stress
a. Preoccupation with problems
b. Frustration
c. Confusing directions/demands
d. Conflicting directions/demands
e. Meaningless or degrading activities
f. Emotional overload
g. Extreme judgement / decision demands
h. Extreme concentration / perception demands
i. Extreme boredom

V. Behavior
a. Improper performance is rewarded
Saves time or effort
Avoids discomfort
Gains attention
b. Improper supervisory example
c. Inadequate identification of critical safe behaviors
d. Inadequate reinforcement of critical safe behaviors
Proper performance is criticized
Inappropriate peer pressure
Inappropriate performance feedback
Inadequate disciplinary process
e. Inappropriate aggression
f. Improper use production incentives
g. Supervisor implied haste
h. Employee perceived haste
VI. Skill Level
a. Inadequate assessment of required skills
b. Inadequate practice of skills
c. Infrequent performance of skill
d. Lack of coaching on skill
e. Insufficient review of instruction to establish skill
VII. Training / Knowledge Transfer

Hi Mr. Vans,
I was informed that Mr. Jeff already prepared a vehicle gate pass for a certain Toyota Hilux but they
have decided to switch that vehicle with another one so I prepared another request for Temporary
Vehicle gate pass for such. Please find the attached documentation for this request.

Thanks and kind regards