Attachment J-0200000-05(k) Crane and Rigging Gear Near Miss Report.pdf
PDF 126 KB Posted
- Solicitation number
- N4008027R1001
About this file
This document is a Crane and Rigging Gear Near Miss Report form and accompanying instructions designed for use by naval activities to report near-miss incidents involving cranes or rigging equipment to the Navy Crane Center.
The form is a standardized template to be submitted via fax to (757) 967-3808 or email to nfsh_ncc_accident@navy.mil without requiring signatures for electronic submission. Key information fields include identification of the near-miss category (crane or rigging gear), reporting activity and UIC number, incident date and time, crane/equipment specifications (number, type, manufacturer, capacity, hook capacity), location and weather conditions, and weight of load on hook. The form requires identification of whether the near miss represents a recurring problem and cross-referencing of related report numbers if applicable. The preparer must document a brief description of the event and corrective actions taken to prevent recurrence, along with contact information and code. The accompanying instruction page provides detailed guidance for completing all 19 fields, defining terms such as service category per NAVSEA 0989-030-7000, crane classification levels (1-4), and requirements for documenting operational parameters at the maximum radius of operation. This form serves as an internal Navy safety reporting mechanism rather than a contract solicitation document.
View the file
Other files
Show 40 more
Latest 50 of 89 listed here. See the rest on GovTribe.
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
CRANE AND RIGGING GEAR NEAR MISS REPORT
Near Miss Category: Crane Near Miss Rigging Gear Near Miss
From:
UIC:
To: Navy Crane Center Bldg 491 NNSY Portsmouth, VA 23709 Fax (757) 967-3808 nfsh_ncc_accident@navy.mil
Activity: Report No:
Crane/Equipment No: Category: Near Miss Date: Time:
hrs
Category of Service: SPS GPS Crane /Equipment Type: Crane/Equipment Manufacturer:
Location: Weather:
Crane/Equipment Capacity: Hook Capacity: Weight of Load on Hook:
Is this near miss indicative of a recurring problem? Yes No
If yes, list report numbers:
In the space below, include a brief description of the event and corrective actions taken to prevent recurrence:
Preparer:
Phone and email
Code Date
ATTACHMENT J-0200000-05 FORMS
CRANE AND RIGGING GEAR NEAR MISS INSTRUCTIONS
This form is designed for fax transmission without a cover page or by e-mail and, with enclosures and signatures shall be the official document. Electronic submission will be accepted without signatures but the names of the preparer, concurring personnel, and certifying official (for crane accidents only) shall be filled in. The e-mail address is nfsh_ncc_accident@navy.mil. The fax number is (757) 967-3808.
1. Near Miss Category: Indicate either crane or rigging gear near miss.
2. From: The naval activity that is responsible for reporting the near miss and UIC number.
3. Activity: The naval activity where the near miss took place.
4. Report No.: The activity assigned near miss number (e.g., 95-001).
5. Crane No.: The activity assigned crane number (e.g., PC-5), if applicable.
6. Category: Identify category of crane (i.e., 1, 2, 3, or 4), if applicable.
7. Near Miss Date: The date the near miss occurred.
8. Time: The time (24 hour clock) the near miss occurred (e.g., 1300).
9. Category of Service: Check the applicable service (SPS as defined by NAVSEA 0989-030-7000).
10. Crane Type: The type of crane involved in the near miss (e.g., mobile, bridge), if applicable.
11. Crane Manufacturer: The manufacturer of the crane (e.g., Dravo, Grove, P&H), if applicable.
12. Location: The detailed location where the near miss took place (e.g., building 213, dry dock 5).
13. Weather: The weather conditions at time of the near miss (e.g., wind, rain, cold).
14. Crane Capacity: The certified capacity of the crane (e.g., 120,000 pounds), if applicable.
15. Hook Capacity: The capacity of the hook involved in the near miss at the maximum radius of the operation, if applicable.
16. Weight of Load on Hook: If applicable, the weight of the load on the hook.
17. Is this a recurring problem? Check yes or no. Identify any other similar near misses or accidents.
18. Situation Description/Corrective Actions: Self-explanatory.
19. Preparer: Self-explanatory.
File details come from the government source that posted it. Updated .