Injured Person POSSIBLE IMMEDIATE CAUSES1. ACTIONSI. Following Proceduresa. Violation by Individual b. Violation by groupc. Violation by supervisord. Operation of Equipment without authoritye. Improper position or posture for the taskf. Overexertion of physical capabilityg. Work or motion at improper speedh. Improper lifting techniquesi. Improper loadingj. ShortcutsII. Use of Tools or Equipmenta. Improper use of equipmentb. Improper use of tools c. Use of defective equipment (Aware)d. Use of defective tools (Aware) e. Improper placement of tool, equipment, or materialsf. Operation of equipment at improper speedg. Servicing of equipment in operationIII. Use of Protective Methodsa. Lack of knowledge of hazard presentb. PPE not usedc. Improper use of PPEd. Servicing of energized equipmente. Equipment or materials not securedf. Disabled guards, warning systems or safety devicesg. Removal of guards, warning systems or safety devicesh. PPE not available IV. Inattention / Lack of Awarenessa. Improper decision making or lack of sound judgement b. Distracted by other concernsc. Inattention to footing and surroundingsd. Horseplaye. Acts of violence f. Failure to warng. Use of drugs or alcoholh. Routine activity without thought

2. CONDITIONS I. Protective System a. Inadequate guards or protective devicesb. Defective guards or protective devicesc. Inadequate PPEd. Defective PPEe. Inadequate warning systemsf. Defective warning systemsg. Inadequate isolation of process or equipmenth. Inadequate safety devicesi. Defective safety devicesII. Tools, Equipment, and Vehiclesa. Defective Equipment b. Inadequate equipment c. Improperly prepared equipment d. Defective Tools e. Inadequate Toolsf. Improperly prepared toolsg. Defective Vehicleh. Inadequate vehicle for the purposeIII. Work Exposures to:a. Fire or Explosionb. Noisec. Energized electrical systemsd. Energized systems, other than electrical e. Radiationf. Temperature extremesg. Hazardous Chemicalsh. Clutter or debrisi. Storms or acts of naturej. Slippery floors or walkwaysIV. Work Place Environment / Layouta. Congestion or restricted motionb. Inadequate or excessive illuminationc. Inadequate ventilationd. 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

POSSIBLE IMMEDIATE CAUSES1. PERSONAL FACTORSI. Physical Capabilitya. Vision deficiency b. Hearing deficiencyc. Other sensory deficiencyd. Reduced respiratory capacitye. Other permanent physical disabilitiesf. Temporary disabilitiesg. Inability to sustain body positionsh. Restricted range of body movementi. Substance sensitivities or allergiesj. Inadequate size or strengthk. Diminished capacity/capability due to medicationII. Physical Conditiona. Previous injury or illnessb. Fatigue due to: Workload Lack of rest Sensory overloadc. Diminished performance Temperature extremes Oxygen deficiency Atmospheric pressure variationd. Blood sugar insufficiency e. Impairment due to drug or alcohol useIII. Mental Status a. Poor Judgement b. Memory Failure c. Poor Coordination or reaction timed. Emotional disturbancee. Fears or Phobiasf. Low mechanical aptitude g. Low learning aptitude h. Influenced by medication IV. Mental Stressa. Preoccupation with problemsb. Frustrationc. Confusing directions/demandsd. Conflicting directions/demandse. Meaningless or degrading activities f. Emotional overloadg. Extreme judgement / decision demandsh. Extreme concentration / perception demandsi. Extreme boredom

V. Behaviora. Improper performance is rewarded Saves time or effort Avoids discomfort Gains attentionb. Improper supervisory examplec. Inadequate identification of critical safe behaviorsd. Inadequate reinforcement of critical safe behaviors Proper performance is criticized Inappropriate peer pressure Inappropriate performance feedback Inadequate disciplinary process e. Inappropriate aggressionf. Improper use production incentivesg. Supervisor implied haste h. Employee perceived hasteVI. Skill Levela. Inadequate assessment of required skillsb. Inadequate practice of skillsc. Infrequent performance of skilld. Lack of coaching on skille. Insufficient review of instruction to establish skillVII. 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

Junard