Incident Reporting

Recording and
Investigation

Document no. ST00.653.1001

Revision 1.1, February 2019

Revision X.Y, Month Year

Incident Reporting Recording and Investigation

Approved by Jim McQueenie Date:

Reviewed by Date:

Prepared by Morgan Adam Date: 14 December 2018

Revision history

Rev Date

1.0 14 Dec 2018 Initial issue (with new document numbering

1.1 9 Feb 2019 New Template

Revision control

Major revisions of this document are to be approved by the approver of the document. These major
revisions are identified by using the next whole number for the revision number. Minor revisions are those
of a minor nature that include changes to references or minor wording and are approved by the author of
the document. Minor revisions are shown by using the next decimal number. In both cases a clear
description of the revision change is to be provided including section numbers where applicable.

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Incident Reporting Recording and Investigation

Contents
1 Purpose 4

2 Scope 4

3 Minimum requirements 4
3.1 Incident Reporting 4
3.2 Incident Classification 6
3.3 Incident Severity Matrix (Actual and Potential) 8
3.4 Incident Category an Required Notification 9
3.5 Incident Notification Escalation 10
3.6 Incident Alerts/Lessons Learned 10
3.7 Incident Investigation 11
3.8 Incident Review 12
3.9 Document Retention 12

4 Compulsory documentation 13

5 Definitions 13

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 Incident Reporting Recording and Investigation

1 Purpose
The purpose of this management standard is to define the minimum requirements for reporting,
recording and investigating any incident arising during the course of Stork’s operations. (For Non-HSE
incidents refer to Management Standard ST00.653.1120 Major Event Reporting).

2 Scope
This management standard is applicable to all Stork businesses globally and shall be referenced when
developing regional and site level procedures to ensure compliance with the standard.

It also applies to those companies/joint ventures where Stork has operational control, and to those
companies/joint ventures that work for Stork as (sub) contractor and where Stork has operational
control. In case of doubt please contact the Stork group HSE team who shall provide support and
assistance in the decision process if a (sub) contractor is in scope or not.

This standard does not address requirements to comply with local legislation / regulations as these shall
be addressed in Regional Management Systems.

3 Minimum requirements

3.1 Incident Reporting

Incidents including Near Misses (NM) shall be reported immediately to the relevant manager.

Unsafe conditions or acts shall not be reported as incidents and shall be reported through a dedicated
unsafe conditions and acts reporting system. (For unsafe conditions and acts refer to Management Standard
ST00.653.1140 Unsafe Conditions and Acts).

All incidents shall be assessed for actual severity (what really happened) and potential severity (realistically
what could have happened) based upon harm to people, the environment and property/equipment.

The Regional VP/Director, Global Director HSE and relevant regional Emergency Management Team, HSSEQ
Lead and Legal Department shall immediately be notified of any Fatalities or life threating injuries.

The Regional VP/Director shall report any fatalities or life threating injuries to the Stork President and
Crisis Management Team within 12 hours.

All incidents shall be reported into the Global Information Management System (GIMS) in line with the
timescales listed in the reporting timescale table below.

Fatalities, Lost Time Incidents (LTI), Restricted Work Cases (RWC), Medical Treatment Cases (MTC) (see
section 3.2 Incident Classification) and High Potential Incidents (HIPO) (see section 3.8 High Potential
Incident Review) shall be reported in English (local language can also be retained). All other incidents may
be reported in the local language.

Following the initial entry in GIMS, the incident record, including injury/illness case classification, may be
updated and revised as more information becomes available through the investigation process.

Incidents shall be reported to local authorities as per country specific regulatory requirements.

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Incident Reporting Timescales

Incident Classification GIMS Reporting Timescale

Fatality Within 24 Hours

High Potential Incident Within 24 Hours

Lost Time Incident Within 24 Hours

Restricted Work Case Within 24 Hours

Medical Treatment Case Within 24 Hours

First Aid Case Within 5 Days

Equipment / Property Damage or Loss Within 5 Days

Environmental Within 5 Days

Motor Vehicle Within 5 Days

Fire Within 5 Days

Near Miss Within 5 Days

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3.2 Incident Classification

Fatality

Death resulting from a work related injury or occupational illness, regardless of the time intervening
between the exposure or incident causing the injury or illness and the death.

Lost Time Incident (LTI)

An injury or illness resulting from a work-related event, or from an exposure in the work environment, which
involves lost days away from work subsequent to the day of the injury. (Irrespective of leave or holidays).

Restricted Work Case (RWC)

A RWC occurs when an employee cannot perform all of their routine job functions, but does not result in
days away from work.
A RWC occurs when, as a consequence of a work related injury or illness:
 The employee is temporarily assigned to another job
 The employee cannot perform all of his routine job functions for all or part of his work shift
 The employee works his regularly assigned job but cannot work the full shift
Any restricted duty on the day of the incident does not make the incident a recordable RWC. If the
employee continues under restricted duties the day after the incident, the case becomes a recordable RWC.

Medical Treatment Case (MTC)

Any work related injury or illness requiring medical care or treatment beyond first aid (regardless of the
provider of such treatment) that does not result in a RWC or LTI. Medical Treatment does not include first
aid treatment (See First Aid) even though provided by a physician or registered professional personnel.

MTC does not include:

 Visits to a physician or other licensed health care professional solely for observation or consulting
 Diagnostic procedures such as x-rays and blood tests
 The use of liquid bandage/surgical glue used to cover a wound
 Any treatment contained on the list of first-aid treatments

The following may not involve any treatment but for purposes of severity classification, shall be reported as
Medical Treatment:
 Any loss of consciousness
 Significant injury or illness diagnosed by a physician or other licensed health care professional for which
no treatment is given or recommended at the time of diagnosis. Examples include: punctured ear drums,
fractured ribs or toes, byssinosis and some types of occupational cancer
 Needle stick injuries and cuts from sharp objects that are contaminated with another person’s blood or
other potentially infectious material
 Occupational hearing loss
 Medical removal under a government standard

Note: First Aid carries a very specific meaning for this purpose – please refer to the definition of First Aid.

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Incident Reporting Recording and Investigation

First Aid Case (FAC)

Where an injury has been sustained and first aid treatment only is received, whether by a first aider or a
medical practitioner such as treatment of minor scratches, cuts, burns, splinters and so forth, and any
follow-up visit for the purpose of observation.

The following are generally considered first aid treatment:

 Using a non-prescription medication at non-prescription strength regardless of route of administration,
i.e. oral, injection, ingestion, inhalation, or absorption
 Administering tetanus immunizations (other post exposure immunizations, such as Hepatitis B vaccine
are considered Medical Treatment)
 Cleaning, flushing, or soaking wounds on the surface of the skin
 Using wound coverings such as bandages, Band-AidsTM, gauze pads, etc.; or using butterfly bandages,
liquid bandage/surgical glue used to cover a wound, or Steri-StripsTM.
(The use of surgical glue to close a wound or other closing devices such as sutures, staples, etc., are
considered Medical Treatment).
 Using hot or cold therapy
 Using any non-rigid means of support, such as elastic bandages, wraps, non-rigid back belts, etc.
(devices with rigid stays or other systems designed to immobilize parts of the body are considered
Medical Treatment)
 Using temporary immobilization devices while transporting an incident victim (e.g. splints, slings, neck
collars, back boards, etc.)
 Drilling of a fingernail or toenail to relieve pressure, or draining fluid from a blister
 Using eye patches
 Removing foreign bodies from the surface of the eye using only irrigation or cotton swab
 Removing splinters or foreign material from areas other than the eye by irrigation, tweezers, cotton
swabs, or other simple means
 Using finger guards
 Using massage (physical therapy or chiropractic treatment are considered Medical Treatment)
 Drinking fluids for relief of heat stress or hypothermia
Equipment / Property Damage or Loss

An incident that does not result in personal injury but does result in damage/loss or wastage to material,
property or equipment. This does not include motor vehicle collisions.

Environmental

Any loss of containment of oil, chemical, hazardous substance, etc. that is not contained within appropriate
bunding, etc. The amount shall be specified. This includes breaches of regulations, permits and airborne
emissions.

Motor Vehicle

Any incident involving a company, rental or personal vehicle while performing company business.

Near Miss

An unplanned or uncontrolled event or chain of events that has not resulted in injury, illness, physical or
environmental damage but had the potential to do so.

High Potential Incident

All incidents with a potential severity of 3 or 4.

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3.3 Incident Severity Matrix (Actual and Potential)

EVALUATION CRITERIA

Severity People Environment / Community Equipment / Property

Long-term (multi-year)
impacts to air, surface /
ground water, or soil, or Expensive losses of high
legal liability for related value equipment / property,
consequences (e.g. or losses exceeding
4 Fatality(ies)
remediation), or widespread $1,000,000 or major
areas including offsite area / unplanned impact on project
community affected, or budget and schedule.
likely adverse publicity /
media coverage.

Long-term, life-altering Lasting up to one year,

injury or illness resulting impacts to air, surface /
Losses of equipment that
in permanent total or ground water, or soil, or
cannot be readily replaced,
partial disability. offsite area / community
or losses exceeding $100,000
3 Examples: amputation affected or events that are
or significant unplanned
including bone, severe reportable to regulatory
impact on project budget
disfigurement, paralysis, authorities or potential for
and schedule.
loss of limb / organ / adverse publicity / media
vision / hearing. coverage.

Injury or illness that

Temporary, up to one
requires medical
month, impacts to air,
treatment or results in
surface / ground water, or
temporary disability or Loss of equipment that can
soil limited to the project
loss of function. be readily replaced, or
site or could create
2 Examples: deep losses exceeding $10,000, or
exposure for potential
laceration, object minor impact on project
breach of regulatory
embedded in eye, bone, budget.
requirement or limit, and
fracture, concussion,
some potential for adverse
dislocation, injury
publicity / media coverage.
requiring surgery.

Injury or illness requiring No direct impact to air,

No impact on equipment
first aid treatment only. surface / ground water, or
functionality.
Examples: minor cuts, soil, or effects restricted
Minor, cosmetic damage, or
1 bruises, sprains, strains, within buildings or
repair costs easily covered
abrasions, irritation, containment structures, and
by normal project operating
inflammation, object in little potential for adverse
budget.
eye removed by flushing. publicity / media coverage.

0 No impact No impact No impact

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3.4 Incident Category an Required Notification

All incidents shall be assigned a category rating (A – F) based on their actual and potential severity.
The required notifications shall be based on the assigned category.

Region / Group Group Fluor

Fluor
Severity Category BL HSE Region VP HSE Presiden Leaders
CEO
Lead Director t hip

Actual: 4
A X X X X X X
Potential: 4

Actual: 3
B X X X X X X
Potential: 3 or 4

Actual: 0,1 or 2
C X X X X X
Potential: 4

Actual: 0,1 or 2
D X X X X
Potential: 3

Actual: 2
E X X X
Potential: 2

Actual: 0 or 1
F X
Potential: 1 or 2

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3.5 Incident Notification Escalation

Key

Immediate phone call

ST00.653.F1115 HSE Incident Communication of Basic Facts within 4 hours

3.6 Incident Alerts/Lessons Learned

A Safety Alert using the ST00.653.F1105 Stork Incident Alert shall be populated and distributed to the
global Stork organisation for all Category A, B and C incidents as soon as reasonably practical after the
incident date. For Category D incidents this shall be done at the discretion of the Regional / Business
Leader HSE Lead. In addition to a local language version, an English version shall also be produced and
distributed.

A Lessons Learned using the ST00.653.F1105 Stork Incident Alert shall be populated and distributed to
the global Stork organisation for all Category A, B and C incidents as soon as possible following the
conclusion of the incident investigation. For Category D incidents this shall be done at the discretion of
the Regional / Business Leader HSE Lead. In addition to a local language version, an English version shall
also be produced and distributed.

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 Incident Reporting Recording and Investigation

Safety Alerts / Lessons Learned shall be developed as follows:

 Local HSE shall develop the first draft of the Safety Alert / Lessons Learned using the
ST00.653.F1105 Stork Incident Alert and submit to the Region/Business Line HSE Lead for review and
approval

 Sensitive information including the names of individuals involved or impacted by the incident,
personal medical information, disciplinary actions, Client and contractor names/logos, etc. shall not
be included

 The Region/Business Line HSE Lead shall review and revise as necessary the Safety Alert / Lessons
and submit to the Global HSE function (and Legal Department for Category A incidents)

 The Global HSE function (and Legal Department for Category A incidents) shall review and
coordinate the distribution of the Safety Alert / Lessons to the global Stork organisation and Fluor
Corporate HSE.

3.7 Incident Investigation

Incident investigations shall be carried out as soon as reasonably practical following an incident. The level
of incident investigation required shall be determined by the incident category.

Investigations shall include immediate, underlying and root causes, with the results recorded in GIMS and
relevant documentation uploaded.

Business Line Operations

Category Investigation / Root Cause Analysis Tool Executive Participation
Required?

Actual: 4
A KELVIN TOPSET, TapRoot or equivalent Yes
Potential: 4

Actual: 3
B KELVIN TOPSET, TapRoot or equivalent Yes
Potential: 3 or 4

Actual: 0,1 or 2
C KELVIN TOPSET, TapRoot or equivalent Yes
Potential: 4

Actual: 0,1 or 2
D KELVIN TOPSET, TapRoot or equivalent No
Potential: 3

Actual: 2
E Unspecified No
Potential: 2

Actual: 0 or 1
F Unspecified No
Potential: 1 or 2

The “Investigation” and “Analysis of Cause” pages in GIMS shall be completed with the results of the
investigation of all incidents with a potential severity level 3 or 4 and all recordable injuries and illnesses.

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Incident investigations shall be recorded using the ST00.653.F1110 Stork Incident Investigation Summary
reviewed, agreed and signed off for all category A, B and C incidents.

“Category A” incident investigations shall be conducted by a team under the direction of the Legal
Department. The Legal Department shall determine the personnel to be included in such team and shall
provide direction on the investigation methodology to use. The Legal Department shall share the findings
of the investigation report and provide advice and counsel to appropriate personnel as defined in the
Business Line HSE Incident Contact List up to and including the Group President. An incident investigation
summary shall be prepared in conjunction with the Legal Department using the ST00.653.F1110 Stork
Incident Investigation Summary and reviewed in a meeting with the Fluor Chief Executive Officer.

Corrective and preventive actions stemming from incident investigations shall be tracked to completion.
Action plans shall include at minimum:

 A description of the action to be executed

 The party responsible for executing the action
 The date the action is due

Following an investigation where it has been deemed that the behaviours of an individual(s) played a part
in the realisation of the incident, the Just Culture framework shall be used as a fair and transparent way
to determine the level of individual accountability, if any.

3.8 Incident Review

 Category A incidents shall be reviewed in a meeting with the Fluor Chief Executive Officer
 Category B incidents shall be reviewed in a meeting with the Fluor Vice President HSE and Fluor
Leadership team
 Category C incidents shall be reviewed internally with the Stork Group President during the monthly
Operations Safety Committee meeting chaired by the Global HSE Director and also in a meeting with
the Fluor Vice President HSE and Fluor Leadership team
 Category D incidents shall be reviewed internally with the Stork Group President during the monthly
Operations Safety Committee meeting chaired by the Global HSE Director

The arrangement and confirmation of these meetings shall be carried out, and then communicated to Fluor
Corporate HSE, by the Stork Group HSE Director.

3.9 Document Retention

Local legislation requirements for documentation retention periods shall always be adhered to.
However for recordkeeping purposes, the following information shall be retained for a minimum of
five years:

 Incident reports
 Incident investigations
 Witness statements
 All photographs / illustrations

External or third party information, related to the reports mentioned above, shall also be retained;
e.g. police reports, incident reports of subcontractors, etc. This information can also be uploaded to
GIMS, where it shall be retained for an indefinite period.

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4 Compulsory documentation
The following documents and tools shall be used in complying with the requirements of this management
standard:

 ST00.653.F1110 Stork Incident Alert

 ST00.653.F1110 Stork Incident Investigation Summary
 ST00.653.F1115 HSE Incident Communication of Basic Facts
 GIMS User Guide

5 Definitions
Incident: A specific unplanned event or sequence of events that has an unwanted and unintended or
potential consequence on health, safety, asset damage or the environment.

Lessons Learned: A formal document that is developed to help identify and share learnings, best practice
and key actions which have been implemented following an incident.

Medical Condition: A previously known medical condition for example, tooth ache, hernia, etc.

Occupational Illness: An Illness is an abnormal condition or disorder other than one resulting from
occupational injury, caused by an exposure to factors associated with employment.

Occupational Injury: Any injury such as a cut, fracture, sprain, amputation etc., which results from a
work-related activity or from an exposure involving a single incident in the work environment.

Permanent Disability: Any work related injury that permanently incapacitates an employee and results in
termination of employment.

Recordable Incident: Fatalities, Lost Time Incidents (LTI), Restricted Work Cases (RWC), Medical
Treatment Cases (MTC).

Unsafe Condition, Situation or Act: A hazardous condition or situation where, unless preventive action is
taken, there is the likelihood of an accident/incident. Any act that deviates from a generally safe way or
specified method of doing a job that increases the potential for an accident.

Work Related: Activities for which management controls are, or should have been, in place. Incidents
occurring during such activities are reportable and shall be included in the statistics.

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