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Acident-Incident Investigation Report

ACIDENT-INCIDENT INVESTIGATION REPORT ACIDENT-INCIDENT INVESTIGATION REPORTACIDENT-INCIDENT INVESTIGATION REPORTACIDENT-INCIDENT INVESTIGATION REPORTACIDENT-INCIDENT INVESTIGATION REPORTACIDENT-INCIDENT INVESTIGATION REPORT

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213 views

Acident-Incident Investigation Report

ACIDENT-INCIDENT INVESTIGATION REPORT ACIDENT-INCIDENT INVESTIGATION REPORTACIDENT-INCIDENT INVESTIGATION REPORTACIDENT-INCIDENT INVESTIGATION REPORTACIDENT-INCIDENT INVESTIGATION REPORTACIDENT-INCIDENT INVESTIGATION REPORT

Uploaded by

engmgs
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOC, PDF, TXT or read online on Scribd
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Name o( )n*$red+

Moshen Yaslam Bayousef


Near Miss First Aid Doctor Case Company ,adge No. Pro*ect ,adge No. SeM F
X

ACC' 7N* / 'NC' 7N* 'N879*'%A*':N F:6M

Date o( ,irt!

OSHA Rec. LWC Fatality Prop. Damage En iromental Ot!er"E#$ipment %Motor &e!icle incident'

N/A
.o/ 0ittle +

N/A (about 32 yrs old)


Ser ice Date

ri!er
S$per isor

2 years
Constr$ction Manager

Nelson Can"o /#$N%

N/A

Project Name : Fab.& Maintenance Contract

Pro&erty ama"e
E#$ipment Damaged 1 Nat$re o( Damage

Personnel 'njury
Nat$re o( )n*$ry 2 ,ody Parts

(ro)n*oyota &ic+,u& (sas) - Plate No. 3,2./0


Date Dammage 3as Reported

Fracture - le1t arm


Date )n*$ry Reported Feb. 202 2344 0reatment Administered 'njured no) in 5os&ital in Mu+alla Wor4 Day Lost ")ncl$si e Date'

Feb. 202 2344


Estimated Repair Cost +

*o be determined later
Estimated Do3n 0ime+

*o be determined later

*o be determined later
0ime E-act Location o( Accident % )ncident

*5e Accident / 'ncident


Date o( Accident % )ncident Day o( Wee4

56 Fe/. 5788
.o/ )n*$red 3as Per(orming+

*5ursday

Aro$nd 6+97 pm

6oad bet)een #$N% (al5al1 ,& #$N% Marib


E-perience 2 0raining On 0!e .o/

*rans&ortin" #$N% material ,(Pi" $aunc5er) escri&tion o1 Accident / 'ncident: On Fe/. 56: 5788 Mr. Mos!en 3as a/o$t to deli er a Pig La$nc!er 1 9;inc! <9= inc! si>e o( a/o$t ?77 4gs in 3eig!t (rom @LNA< ,al!al( to @LNA<Mari/. W!ile on !is 3ay to Mari/ at t!e section o( t!e road 3!ere t!e accident !appened:one car "not identi(ied' passed %o ertoo4 Mr. Mos!en 0oyota pic4<$p.0!e $nidenti(ied car created a d$st clo$d t!at made isi/ility ery poor prompted Mr. Mos!en stired t!e 3!eel to !is rig!t side /$t !is tires 3ent o(( t!e road to t!e sandy side o( t!e trac4 : !e t!en tried to go /ac4 to t!e road3ay /y stirring t!e 3!eel to !is le(tside /$t t!e 0oyota pic4<$p t$rned to its side 3!en t!e 3eig!t o( its load "pig la$nc!er' s!i(ted to3ards t!e same direction. Mr. Mos!en said !e 3as r$nning aro$nd ?7<=7 4p! 3!en t!e accident !appened. Mr. Mos!en s$stained (ract$re on !is le(t arm. At (irst !e 3as /ro$g!t at t!e near/y !ospital in t!e area t!en: !e 3as airli(ted to @LNA clinic at aro$nd ?+97 pm o( t!e same day. At present Mr. Mos!en is at Hassany Hospital in M$4alla /eing ta4en care o( /y 0ANM)A administration personnel. Doctors per(ormed operation to (i- !is (ract$red arm and 3as a ised to stay (or at least 87 days. Note+ A/o e in(ormation is ta4en (rom t!e in*$red person t!r$ telep!one. 0!e in*$red person stated t!at t!e (ollo3ing conditions contri/$ted to t!e accident+ 8' Pic4 $p 3as o erloaded 5' o erta4ing in d$sty road 0ANM)A is arranging (or t!e reco ery o( t!e damaged 0oyota Pic4 1Bp.

Accident % )ncident )n estigation Doc$ment "HSE<6<755' Re ision 7: .an$ary 5787

Accident *y&e or Contact


C!ec4 One Str$c4 ,y Contacted ,y Str$c4 Against Contact Wit! Fre#$ency Potencial Fre#$ent Name o( Witness+ Occasional
X

Ca$g!t )n Ca$g!t On

Ca$g!t ,et3een Same Le el Fall

Di((erent Le el Fall Strain%O er E-ertion Se erity Potential


X

E-pos$re Ot!er"E-plain' M8A

Rare

Ma*or

Serio$s

Rare

Not a/le to identi(y irect Personnel Cases *5e Causes X irect 7n!iromental Causes
W!at de(ecti e or ot!er3ise $nsa(e condition"s' o( tools: mac!inery: e#$ipment: prod$ct: 3or4ing s$r(ace: str$ct$res: or 3or4 area contri/$ted directly to t!is accidentC ,e speci(ic: (or e-ample+ DHand 1 railing missingE. D,adly 3orn /ra4e liningsE: DCrac4ed (or4 on li(t tr$c4.E

W!at did a person 1t!e ictim or someon e else<do: t!at contri/$ted directly to t!is accidentC.

'ndirect Personnel Causes


C!ec4 item"s' /elo3 3!ic! /est indicate reason 3!y act indenti(ied in a/o e 3as commented. Write in in(ormation (or indirect ca$ses not listed.

'ndirect 7n!iromental Causes


C!ec4 item"s' /elo3 3!ic! /est indicate reason 3!y condition identi(ied in a/o e e-isted. Write in in(ormation (or indirect ca$ses not listed

x x

8. 5. 9. 6. F. ;. ?.

Bna3are o( *o/ !a>ard )nattenti e to !a>ard Bn3are o( sa(e met!od Lo3 le el o( *o/ s4ill
0ried to gain or sa e time 0ried to a oid e-tra e((ort Acted to a oid discom(ort

=. G. 87. 88. 85. 89. 86.

)n(l$ence o( emotion )n(l$ence o( (atig$e )n(l$ence o( illness )n(l$ence o( into-icants De(ecti e ision%!earing Bna/le to determine Ot!er "e-plain'

8. 5.
9.

Worn o$t (rom normal $se A/$se or mis$se /y $sers


Re#$ired inspection not done

6. F. ;. ?. =. G. 87.

)nspection not re#$ired Clean<$p (ail$re Clean<$p not re#$ired Clean<$p not done )nade#$ate entilation Congestion1lac4 o( space Bnsa(e design

88. Fa$lty constr$ction 85. )nade#$ate ill$mination 89. L$/rication (ail$re 86. E-pos$re to corrosion 8F. E-pos$re to i/ration 8;. E-pos$re to temp. e-treme 8?. 0ampering 8=. S$per isor (ailed to correct 8G. Bna/le to determine 57. Ot!er "e-plain' usty road, &oor !isibility
(C5ec+ :ne)

Primary ;nsa1e Act


Causes
8. 5. 9. 6. F. ;. ?. =. G. 87. 88. 85. 89. 86. Operating or $sing e#$ipment 3it!o$t a$t!ority Fail$re to sec$re against $ne-pected mo ement Operating or 3or4ing at an $nsa(e speed Fail$re to signal as re#$ired Remo ing or ma4ing sa(ety de ices inoperati e Bsing de(ecti e tools or e#$ipment Bsing tools or e#$ipment $nsa(ely 0a4ing an $nsa(e position or post$re Ser icing mo ing energi>ed or ot!er3ise !a>ardo$s e#$ipt. Riding !a>ardo$s mo ing e#$ipment Horseplay: distracting: startling: teasing: etc. Fail$re to 3ear personal protecti e e#$ipment Ot!er t!an a/o e None

Primary ;nsa1e Condition


7n!iromental Cause
8. 5. 9. 6. F. ;. ?. =. G. 87. 88. 85. 89.

Lac4 o( inade#$ate g$ards and sa(ety de ices Lac4 o( or inade#$ate 3arning system Fire and e-plosion !a>ards Bne-pected mo ement !a>ard Poor !o$se4eeping !a>ard Protr$ding o/*ect !a>ard Close clearance and congestion !a>ards Ha>ardo$s atmosp!eric conditions Ha>ardo$s arrangement: placement or storage Ha>ardo$s de(ects o( tools: e#$ipment etc. )nade#$ate ill$minationH intense noises Ha>ardo$s personal attire ":t5er) :!erloadin" o1 &ic+ ,u&

*5e Correction Correcti!e Action *a+en


C!ec4 t!ose actions ta4en to pre ent reoc$rrence. Fill in t!e appriate /o- (or correcti e actions decided $pon or planned /y not yet initiated or completed.
X

Accident % )ncident )n estigation Doc$ment "HSE<6<755' Re ision 7: .an$ary 5787

8. 5. 9. 6. F. ;. ?.

Reinstr$cted o( t!ose in ol ed Reprimand o( t!ose in ol ed Desipline o( t!ose in ol ed Reinstr$ction o( ot!ers doing t!e *o/ 0emporary reassignment o( person Permanent reassignment o( person Action to impro e inspection

=. G. 87. 88. 85. 89. 86.

Action to impro e clean<$p E#$ipment repair or replacement Action to impro e design Action to impro e constr$ction )nstallation o( g$ard or sa(ety de ice )n(orm all department s$per ision C!ec4 3it! man$(act$rer

8F. Correction o( necessary congestion 8;. )mpro ed personal protecti e e#pt. 8?. X Order reg$lar pre<*o/ instr$ction 8=. Order $se o( sa(er materials 8G. Ot!er t!an a/o e. <<< e1ensi!e ri!in" Course 1or ri!er and Material =andlin" 9a1ety.

Person responsi/le (or Correcti e Action

Nelson Can"o2 6od 9an"alan"


)n estigated ,y+ "Name 2 Signat$re' Date

0arget Date Marc5 4>2 2343 Pro*ect %Constr$ction Manager "Name 2 Signat$re'

Date Completed *(A Date Feb. 2/2 2343

6od 9an"alan"
Sa(ety Representati e "Name 2 Signat$re Cra(t S$per isor "Name 2 Signat$re'

2/ Feb. 2343 6odri"o 9an"alan" Nelson Can"o

Nelson Can"o

Accident % )ncident )n estigation Doc$ment "HSE<6<755' Re ision 7: .an$ary 5787

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