| S.No. | Checkpoint | IS Requirement | Status |
|---|---|---|---|
| A. Incident Details & Classification | |||
| A1 | Date of Incident - Record the exact date when the incident occurred (may be different from report date if delayed reporting) Acceptance: Date must be accurate and match site records; used for trend analysis | Mandatory | OK NC NA HOLD |
| A2 | Time of Incident - Record exact time of incident (hour and minute). This helps reconstruct events and identify contributing factors Acceptance: Time must be precise; use 24-hour format for clarity | Mandatory | OK NC NA HOLD |
| A3 | Location on Site - Specify exact location where incident occurred. Reference to drawings (grid, level, area). Example: Grid B/3, Level 4, Steel Column C-12 area Acceptance: Location must be precisely identifiable on site; traceable to drawings | Mandatory | OK NC NA HOLD |
| A4 | Type of Incident - Select: (1) Injury - Lost time or medical treatment required, (2) Near-Miss - Potential for injury but no actual harm, (3) Property Damage - Damage to equipment/structure, (4) Environmental - Spill, pollution, emission Acceptance: Type must be clearly classified; correct category determines investigation depth | Mandatory | OK NC NA HOLD |
| A5 | Severity Level - Select: (1) Minor - First aid only, no lost time, (2) Serious - Medical treatment required, lost time injury, (3) Fatal - Fatality occurred or imminent risk of death Acceptance: Severity must be objectively assessed; triggers escalation and authority notification | Mandatory | OK NC NA HOLD |
| B. Person(s) Involved | |||
| B1 | Injured Person's Name & ID - Full name, employee ID, date of birth. If multiple persons involved, list all. For contractors, include contractor company name Acceptance: Complete identification with ID number; records match payroll/contractor database | Mandatory | OK NC NA HOLD |
| B2 | Designation / Role - State the worker's designation (mason, carpenter, electrician, site supervisor, etc.) and contract type (permanent, casual, contractor) Acceptance: Role must be specified; designation helps identify hazard exposure pattern | Mandatory | OK NC NA HOLD |
| B3 | Company / Contractor - If contractor worker, state contractor name and supervisor name. Document period of employment and safety induction completion Acceptance: Contractor details traceable; safety induction verification required | Mandatory | OK NC NA HOLD |
| B4 | Experience / Tenure - State years of experience in current role and total construction experience. New workers (< 3 months) have different risk profile Acceptance: Experience documented; helps identify if lack of training is contributing factor | Recommended | OK NC NA HOLD |
| B5 | Injury Description - Detailed description of the injury (laceration, fracture, burn, eye injury, crush injury, etc.). Body part affected. Estimated severity (minor wound, bleeding, suspected fracture, etc.) Acceptance: Injury clearly described; medical assessment confirms severity | Mandatory (if injury incident) | OK NC NA HOLD |
| B6 | First Aid Given - Describe what first aid was provided on site (wound cleaned, bandaged, ice applied, etc.). By whom (first aider, site supervisor). Time first aid started Acceptance: First aid actions documented; first aider identified; effectiveness assessed | Mandatory (if injury incident) | OK NC NA HOLD |
| B7 | Hospital Referral - Was worker referred to hospital/medical facility? State: Yes or No. If Yes, which hospital, date/time of referral, mode of transport, accompanying person Acceptance: Medical referral documented; hospital confirmation obtained; follow-up initiated | Mandatory (if injury incident) | OK NC NA HOLD |
| B8 | Lost Work Time - If injury resulted in lost time, state number of hours/days unable to work. Track return-to-work date and any temporary duty restrictions Acceptance: Lost time documented; return-to-work date recorded; medical restrictions noted | Conditional | OK NC NA HOLD |
| C. Incident Description - What Happened? | |||
| C1 | Detailed Narrative - Provide a step-by-step account of events leading to the incident. Example: "Worker was climbing scaffolding on north face. At 2:30 PM, a vertical support member connection failed. Worker fell approximately 4 meters onto safety net." Acceptance: Narrative clear, factual, chronological; includes timing and sequence; avoids blame language | Mandatory | OK NC NA HOLD |
| C2 | Work Activity Being Performed - What was the worker doing when incident occurred? Example: "Concreting roof slab of Block C. Worker was placing concrete from a bucket hoisted by crane. Bucket sling broke, spilling concrete." Acceptance: Activity clearly described; work procedure reference included if applicable | Mandatory | OK NC NA HOLD |
| C3 | Site Conditions at Time of Incident - Describe weather (rain, wind, heat), lighting, ground conditions, congestion, noise levels, etc. Example: "Heavy rain, poor visibility, scaffolding wet and slippery, no proper lighting" Acceptance: Environmental factors documented; may reveal systemic issues | Mandatory | OK NC NA HOLD |
| C4 | Equipment / Tools Involved - List any equipment, tools, or machinery involved. Example: "Steel scaffolding, welded connection, worker harness and lanyard, safety net" Acceptance: All relevant equipment listed; condition noted (e.g., net had previous damage) | Mandatory | OK NC NA HOLD |