SERIOUS Near Miss

Event Description

10th August 2014

NMDC Roller operator having been given a compaction assignment proceeded to refuel his machine prior to moving on to the work
area. At the same time his assigned banks-man proceeded to the rest room.
Upon completion of refueling he proceeded to his assigned area for compaction. While the roller compactor was maneuvering
inside the barricaded area he reversed onto a pick-up vehicle that also entered the barricaded area to carry out visual inspection
without authorization. No injury to the Pick-up driver.

Causal Factors:
Pickup truck entered in the barricaded area.
Operator Reversed without Banks-man
Roller operator did not inspect vicinity before reversing

Root Causes:

Procedures not available

Inadequate Training
Improper Communication
Human Engineering (Inadequate barricading & No warning signs in place)
Work Direction (Inadequate Supervision)

Findings:

The pickup cars driver has no UAE driving license.

The pickup car entered the restricted/barricaded area without authorization.
The roller operator proceeded without the Banksman.
The roller operator did not inspect vicinity before reversing
General PTW is being used for this activity.
No Pre-start Safety Review (the 5-minute risk assessment) was carried out.
No JSA, 5-minute risk assessment, MS specific to the activity was available.
Roller Operator and the pick-up driver did not participate in WI Safety Day presentation Blind Spot
Existing gaps between Jersey barrier allow pick-up to enter to the restricted area.
No warning signs in place restricting access to authorized personnel
No adequate supervision at worksite

Recommendation:
All parties to fully enforce the "No UAE driving license, No driving" policy. Drivers must be licensed and appropriately trained
for the class/type of vehicles or equipment that they operate.
Review banks-man requirement during operation/manoeuvring of heavy equipment.
Site supervisors to ensure that all control measures (JSA, 5-minute risk assessment, Pre-task review, etc.) are utilized prior to
start any activities.
Develop and issue Safety Flash Alert to all contractors the lessons learnt and recommendations.
Stand down meeting to be conducted with all supervisors, foreman, operators and drivers.
All pick trucks and buggies to be equipped with rotating amber lights and warning flags
Contractor to review the effectiveness of their PTW System. Area Authority & the Performing Authority need to ensure that
TBT, MS, JSA reflect the work activity.
Contractor to conduct refresher course on Man Machine interface and focus on blind spots.
HSE induction to be updated by adding Driving on site is NOT allowed without a UAE driving license