J-0200000-05-04 Crane and Rigging Gear Near Miss Form.pdf
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- Attached to
- PAX FSS Amendment 005 and Current CBAs
- Solicitation number
- N4008020R0001
About this file
This document outlines requirements for facility support services at Naval Air Station Patuxent River in Maryland. The indefinite delivery, indefinite quantity contract will have a total small business set-aside and require base access for site visits. Services include scheduled custodial work, pest control, grounds maintenance and landscaping, pavement clearance such as snow removal, and transportation functions like vehicle maintenance and material handling. The Naval Facilities Engineering Command will award the contract for facility support at the Naval Air Station to ensure cleanliness and upkeep of buildings, pest prevention, lawn care, debris removal, paved area clearance, and vehicle/equipment operations and repairs.
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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.
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
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