Main contractor name LTI Date of incident Incident

  • Slides: 3
Download presentation
Main contractor name – LTI# - Date of incident Incident details Contractor name/number :

Main contractor name – LTI# - Date of incident Incident details Contractor name/number : (subcontractor-PDO)/CXXXXXX Incident owner : Name / Ref Ind Location Area / unit - (road/yard/station/rig/hoist/plant etc) : Incident date & time Incident type : : (d/m/yr) / (24 hour clock) – advise if estimated Fatal, LWC, high potential, significant incident etc Actual severity rating : Number (1 -5) / letter (P, E, A, R) – from RAM Potential risk rating : Letter (A-E), Number (1 -5)/letter (P, E, A, R) from RAM Description of Injuries : Worst injuries (fractures, head injury, amputation etc) FIM ID No : Number assigned in FIM Immediate cause : Short description of what caused harm Key underlying cause : Main learning from investigation 1

Main contractor name – LTI# - Date of incident Description of the incident: This

Main contractor name – LTI# - Date of incident Description of the incident: This should include the relevant facts explaining what happened including all relevant parties • Leading up to the incident • Immediately before the incident • During the incident • Immediately after the incident • In the emergency escalation of the incident Important Note: This should be in sufficient detail to allow a person who does not know anything about the incident to imagine it. It should only be about what happened and not why it happened. Do not include investigation findings here, simply describe the incident as the investigation has shown it happened. For complex incidents involving the interaction of several different parties, a timeline can be added on a separate slide immediately after this one. 2

Main contractor name – LTI# - Date of incident Declaration of close out of

Main contractor name – LTI# - Date of incident Declaration of close out of incident redline recommendations: The five redlined actions to prevent a reoccurrence in the future have been closed out as follows and I confirm I have seen appropriate evidence to confirm this by my signature below: Recommendation Action Party (Contractor/PDO) Incident Owner signature: _____________ Description of action taken Name/Ref Ind: ____________ Target Date Complete Date: ________ 3

Main contractor name LTI Date of incident IncidentMain contractor name LTI Date of incident Incident
HSE name Incident Investigation Main contractor LTI DateHSE name Incident Investigation Main contractor LTI Date