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Petroneeds Services International: Incident Report Form

This incident report describes a medical treatment injury that occurred on February 4, 2012 at 11:30am at Rig 102. Mohammed Haj Hamad, a 28 year old Sudanese floorman, injured his thumb when it was pinched by a hydraulic tongue while racking it back. His finger was hurt badly and his nail was moved inside, but no bones were broken. The immediate cause was that he was not concentrating while working. He was taken to the clinic for first aid and then to the hospital for an x-ray due to pain. To prevent recurrence, personnel need to take responsibility and be fully aware when working on the rig floor.

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Khalid Mahmoud
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38 views

Petroneeds Services International: Incident Report Form

This incident report describes a medical treatment injury that occurred on February 4, 2012 at 11:30am at Rig 102. Mohammed Haj Hamad, a 28 year old Sudanese floorman, injured his thumb when it was pinched by a hydraulic tongue while racking it back. His finger was hurt badly and his nail was moved inside, but no bones were broken. The immediate cause was that he was not concentrating while working. He was taken to the clinic for first aid and then to the hospital for an x-ray due to pain. To prevent recurrence, personnel need to take responsibility and be fully aware when working on the rig floor.

Uploaded by

Khalid Mahmoud
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Petroneeds services international

HSE DEPARTMENT
INCIDENT REPORT FORM

Report No.: ___1____________

1-Company / Petroneeds

2.Location of event 3.Time/Date Occurred 4.Time/Date Reported

Abugabra6-rig102-Rig floor 2/04/2012,11:30am 2/04/2012,23:00

5- Incident Type:
( ) Fatality ( ) Serious injury ( * ) Medical treatment
( ) First Aid Case ( ) Fire ( ) Explosion
( ) Oil Spill ( ) Property Damage ( ) Motor Vehicle Accident
( ) Fall from hight
( ) Near Miss
6- Details of the injured:

Name: ___Mohammed Haj Hamad__________ Age (years): ______28_____

Nationality: Sudanese Position: floorman

Part of bodyinjured: __finger(thumb)______


_______________________________________________

7- Details of Property Damage:


No property damage
_________________________________________________________

Estimated Cost of Damage (in USD):.

8- Person in Control of Property:

Name: ______ Company:


Position __ ______________
9- Brief description of event (s) leading to the incident:
While he was using the hydraulic tongue on the floor, the tongue harmed him.

10- Immediate cause of the incident (describe the unsafe acts and unsafe
conditions):
he was racking it after using, his finger of his hand that gripping the other side
of the hydraulic tongue was in the wrong place, then when the tongue racked
back, it pomp his finger and hurt it badly, while the nail of the finger moved
inside, but no bones broke.

11- Basic or root cause of the accident:


He was not concentrated while he is working.

12- Immediate action taken to control the situation / prevent recurrence:


We took him to the clinic, to make the first aid, then took him to Moglad to make
the X-ray, cause he was paining hardly.

13- Management corrective action required preventing similar occurrence:

Aware the personnel to take their responsibility and be completely aware when they
are on the floor.

Reported by:
Name: talal mohammed jabir… …… Signature: _____________________
Position: HSE Officer … ……………… Date: …2/04/2012………
Approved by:
Name: Anwar B.Bushara ___ Signature: _____________________
Position: Rig manager___________ ____________________

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