FARABI YANBU PETROCHRMICALS

MAJOR PROJECTS / LAB#4 PROJECT

INCIDENT RMCO-IR-003 INCIDENT REPORT No# …NM-003
Project Name FARABI LAB#4 Project Number 22098
Reporting Company: WISON Date Of Report: 08-05-2024
From: Abdul Qadeer HSE Manager To: Mohammad Atif Project Manager
Incident Information
Incident/Injury Near Miss Incident Environmental Incident
 Injury: ■ Potential injury  Emission to atmosphere
 First Aid  Potential environmental incident  Water discharge
 Potential Health damage  Waste
 Medical Treatment
 Little spill  Ground disturbance
 Restricted Work Case
 Little gas emission  Noise not normal
 LTI  Little chemicals discharge  Smell
 Fatality  Potential damage to process/equip.  External compliance

 Occupational Illness  Potential damage to equipment  Smoke / Dust

 Fire / Explosion  …………………………  Spill / Gas Leak

 Collapse  ………………………….  ……………………………..

 Damage to property  ………………………….  ……………………………..

 Vehicle incident
 …..………………………
Place of the Incident: Date and Time of Event: Company Involved:
Dyke wall# 1 (Tank Area) 08-05-2024 01:35:00PM RMCO

POTENTIAL RECURRENCE/SEVERITY POTENTIAL RISK

Potential recurrence:  A B ■C D  E  R High (64-

 R Low (1-8) ■ R Medium (16-32)
Severity Level:  1 2 ■ 3  4  5 256)
Overall Severity of Incident: (Refer to Incident Severity Determination Sheet, Annex C):
□ Minor ■ Significant □Major
Name Of Injured Personnel N/A Company RMCO

Job Title N/A Duration in present job N/A

Parts of Body Injured: N/A Nature of Injury / Illness: N/A

Name of Hospital and Treatment N/A N/A

Lost Work Days Number
Given:

Property Damaged/Type N/A Damage Description N/A

Operator/Supervisor N/A Cost Of Repair N/A

Environmental Impact Type N/A Duration of Spill/ Release N/A

Name of Chemical N/A Quantity of Spill/ Release N/A

Investigation Information
 FARABI YANBU PETROCHRMICALS
MAJOR PROJECTS / LAB#4 PROJECT

Event Description and Treatment –description reporting also people / tools / equipment, Type of contact (i.e. stroked, caught in/on,
fall, etc.), source of hazard (i.e. Scaffold, excavation, lifting, process equipment, etc.) the action done to return to normal condition,
and the first solution adopted. Use only known facts. Do not speculate on cause, fault or error

On May 08, 2024, at approximately 01:35 PM at the Dyke Wall # Tank area, two workers were engaged in carpentry
activities on a 3-meter-high scaffolding when one of the carpenters mistakenly hit a loose clump of Scaffold with His
foot. The clump fell from the platform of the scaffolding and landed within close proximity to the worker, narrowly
missing them.

Attachments – Witnesses/involved personnel Statements, Event Sharing session, Attendance sheet, Photos, Disciplinary
action/warning letters.

Item Date Company Subject

1 11-05-2024 RMCO Event an Lesson learned Sharing (TBT) Photos

2 11-05-2024 RMCO Event Sharing Attendance Sheets.

3 09-05-2024 RMCO Involved Personnel Statement report

4 08-05-2024 RMCO Scaffolding Inspection Report & Photos

5 09-05-2024 RMCO Stand-down Meeting With Scaffold Team

Immediate Causes – Report immediate causes at first instance. Consult the following list and describe more as needed. Check below
which causes best indicate reason for existence of acts and/or conditions identified. Add other causes if not listed. Why it happened? –
Which condition was under-standard? - Generally more than one.

People Organization-Environment-Technology

1 Bypassed Control / Shortcut 1 Inadequate Permit / Not Following Permit

Disabled / Removed Guard / Warning System / Safety

2 2 Poor Job Plan
Device /Shortcut

3 Failure To Act 3 Exposure To Extreme / Unexpected Weather

4 Failure To Obey / See Safety Systems / Controls / Barriers 4 Exposure To Extreme Temperature / Humidity / Dust

5 Failure To Secure 5 Exposure To Hazardous Atmosphere

6 Inadequate Pre Task Checking 6 Inadequate Ventilation / Light / Illumination

Inappropriate Manual Handling / Use Of Equipment /

7 7 Natural Effects (Flooding, Landslides Etc.)
Tools

8 Inappropriate Position Of Person(S) 8 Slippery Or Uneven Surface / Obstruction Etc.

9 Incorrect Loading / Stacking 9 Unprotected Height Risk

10 Lapse, Mistake, Omission 10 Exposure To Hazards E.G. Fire, Chemical, Noise Etc.

11 Operated Without Authority / Permission 11 Falling / Incorrectly Placed Objects / Materials

Improper Loading / Storing / Positioning Of Material /

12 Operating Equipment / Vehicle At Improper Speed Etc. 12
Equipment
 FARABI YANBU PETROCHRMICALS
MAJOR PROJECTS / LAB#4 PROJECT
13 Slips, Trips, Falls 13 Ineffective Guards / Warning Systems / Safety Device / PPE Etc.

14 Under Influence of Alcohol / Drugs 14 Leakage (Fuel, Radiation, Chemical, Gas) Etc.

15 Unsafe / Inappropriate Act / Horseplay 15 Plant / Equipment Status Was Not Correct

16 Used Faulty / Defective Tools / Equipment 16 Technical / Mechanical Failure / Faulty Equipment Etc.

17 Worked On Equipment In Operation / Live 17 Undetected / Unforeseen Hazard / Failure

18 Other 18 Other

Immediate Causes – Report The Immediate Causes And Describe More If Needed.

1 Disabled / Removed Guard / Warning System / Safety Device /Shortcut

2 Inadequate Pre Task Checking

3 Falling / Incorrectly Placed Objects / Materials

4 Unprotected Height Risk

Underlying Causes – Which specific human factor or work factor have leaded to immediate causes (at least one for each immediate
causes)? – Why that act or condition was present? - The root causes shall be removed by an action plan.

1 Deliberate infringement / violation / action 25 Conflicting objectives / goals / standards

2 Extreme work demands / fatigue 26 Financial, resource constraints / purchasing / procurement

3 Followed usual custom & practice 27 Inadequacies in shift handover

4 Illness / injury 28 Inadequate correction of prior hazard / incident / condition

Inadequate leader knowledge, ability/supervise./decision

5 Inadequate reaction to changing circumstances 29
make

6 Lack of attention / due care / poor work practice 30 Inadequate planning / risk assessment

7 Lack of awareness / perception of risk 31 Inadequate safety controls / warning systems / signs

8 Lack of knowledge of task / procedure / permit 32 Inadequate training / guidance provision / qualifications

9 Lack of skill / knowledge / experience / training 33 Inadequate work planning / programming

Miscommunication / inadequate communication of

10 34 Ineffective auditing / inspection / monitoring
instructions

Not following / incorrect following of standards /

11 35 Ineffective identification of hazards
procedures

12 Not using / incorrect use of PPE 36 Ineffective management of change

 FARABI YANBU PETROCHRMICALS
MAJOR PROJECTS / LAB#4 PROJECT
Ineffective standards/ enforced/procedures/guidelines/
13 Physical / mental capability / stress problems / fatigue 37
instruct.

14 Poor decision-making / judgment 38 Lack of / ineffective job plans (toolbox talks etc) / ptw

Poor team relationships / dynamics / tensions (social /

15 39 Lack of accountability / responsibility
cultural)

16 Design deficiencies 40 Lack of means of communication

17 Excessive wear & tear of tools / equipment 41 Missing or inadequate job safety analysis

18 Improper identification of hazardous materials 42 Poorly controlled contractors / external people

19 Improperly prepared tools / equipment 43 Security breach

20 Inappropriate equipment / vehicle for not fit for purpose 44 Unclear / conflicting lines of responsibility

21 Ineffective adjustment / repair / maintenance 45 Inappropriate construction / layout

Ineffective fire / explosion / radiation / chemical /

22 46 Insufficient / restricted access & exits
electrical protection

23 Lack of correct tools / equipment / power 47 Poor housekeeping / disorder

24 Other 48

Underlying Causes - Report the Underlying causes and describe more if needed

1 Lack of awareness / perception of risk

2 Improper identification of hazardous materials

3 Inadequate planning / risk assessment

4 Poor housekeeping / disorder

Corrective Actions – Report identified actions to remove root causes and prevent recurrence – Use the following guideline as
needed. Report in sequence of priority. Assign a target time and person/company responsible to complete the corrective action and
give fee-back of completion. Try to be S.M.A.R.T (Specific, Measurable, Achievable, Realistic, Timed)

 Refresh training of those involved  Procedure and instruction new/review  Improve clean-up
 Reprimand of those involved  Communication reinforcement  Correction of necessary congestion
 Discipline of those involved  Task assignment revision  Order use of safer materials
 Improve discipline/Incentive scheme  Job hazard Analysis review  Check with manufacturer
 Reinstruction of others doing the job  Tool Box Meeting enforcement  Improve design
 Temporary reassignment of person  Order regular pre-job instructions  Improve construction
 Permanent reassignment of person  Improve inspection  Installation of guard or safety device
 Improve leadership  Improve maintenance  General audit requested
 FARABI YANBU PETROCHRMICALS
MAJOR PROJECTS / LAB#4 PROJECT
 Review of organization and resource  Equipment repair or replacement  Stand down organization
 Training reinforcement  Improvement of PPE  Improve environmental practices

Close Out
Corrective Action Plan To Be Executed By
Date

A  Reinstruction of others doing the job HSE 09/05/2024

B  Tool Box Meeting enforcement HSE 11/05/2024

C  Improve inspection CONSTRUCTION 09/05/2024

D  Installation of guard or safety device HSE 08/05/2024

*This report shall not be considered closed until all corrective actions have been completed.
FARABI YANBU PETROCHRMICALS
MAJOR PROJECTS / LAB#4 PROJECT