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CODE OF PRACTICE ON
EHS INCIDENT REPORTING & INVESTIGATION
ZonesCorp CoP - EHS05
APPROVED BY: DATE:
21 SEP2008
CODE OF PRACTICE
EHS INCIDENT REPORTING & INVESTIGATION



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ZonesCorp Environment Health & Safety Code Page 2 of 67

REVISION HISTORY

Rev. No. Issue Date Revised Section Revision Description
0 New Document





Copyright

The copyright and all other rights of a like nature in this document are vested in Higher Corporation for
Specialized Economic Zones (ZonesCorp), Abu Dhabi, United Arab Emirates. This document is
issued as part of the Industrial Sector EHS Regulatory Framework and as guidance to Industrial
Sector within the Abu Dhabi Emirates. Any party within Industrial Sector may give copies of the entire
EHS Documents or selected parts thereof to their contractors/consultants for implementation of EHS
Management Standards. Such copies should carry a statement that they are reproduced by
permission of ZonesCorp and an explanatory note on the manner in which the document is to be
used.

Disclaimer

No liability whatsoever in contract, tort or otherwise is accepted by ZonesCorp or any party whether or
not involved in the preparation of the EHS Management System Documents for any consequences
whatsoever resulting directly or indirectly from reliance on or from the use of the ZonesCorp EHS
Documents or for any error or omission therein even if such error or omission is caused by a failure to
exercise reasonable care.

All administrative queries should be directed to the ZonesCorp EHSMS Administrator HSE Division

Higher Corporation for Specialized Economic Zones
P.O. Box: 36000, Abu Dhabi,
United Arab Emirates.
Telephone: (9712) 5073358
Fax: (9712) 5073564
Internet site: www.zonescorp.com
E-mail: hse@zonescorp.com
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TABLE OF CONTENTS

1 Purpose 4
2 Scope 5
3 Definitions 5
4 Existing Applicable Laws 11
5 Responsibilities 13
6 Requirements 15
7 References 30
8 Appendix 1: Incident Severity Assessment Guidelines 31
9 Appendix 2: Guidelines for Injuries Classification 36
10 Appendix 3: Guidelines for Establishing the Work Relationship 41
11 Appendix 4: Loss Causation Model 48
12 Appendix 5: ZonesCorp EHS Division Contacts 58
13 Initial Incident Notification Report Form ZC-COPEHS05-F001 59
14
Incident Investigation Team Leaders Preparations Checklist
Form ZC-COPEHS05-F002
60
15 Incident Witness Statement Form ZC-COPEHS05-F003 61
16 Incident Interview notes/Checklist Form ZC-COPEHS05-F004 62
17 Incidents Preliminary Investigation Form ZC-COPEHS05-F005 64
18 Incident Investigation Summary Report ZC-COPEHS05-F006 65
19 Incident Analysis Form ZC-COPEHS05-F007 66
20 EHS Incident Statistics Report Form ZC-COPEHS05-F008 67
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1. PURPOSE

This document outlines detailed requirements for Reporting, Classification,
Investigation and Analysis on a consistent basis of all Workplace
Environmental Health & Safety (EHS) Incidents. The document also includes
the mandatory guidelines for determining severity of EHS incidents,
classification of injuries and the formats recommended for use in notification,
investigation and analysis of EHS Incidents.
Based on the power vested by the Executive Council of Emirates of Abu
Dhabi on the EHS Higher Committee, it has designated Higher Corporation
for Specialized Economic Zones ZonesCorp as the EHS Regulatory
Authority for the Industrial Sector within Abu Dhabi Emirate. Also the
Executive Council has designated the Environment Agency Abu Dhabi (EAD)
as the Competent Authority of EHS Management within Abu Dhabi Emirate.
ZonesCorp in its Regulatory Role is the nodal agency for the Entities within
Industrial Sector while interacting with concerned Govt. Agencies (EAD, Civil
Defense etc.) for fulfilling the applicable regulatory requirements like EHS
Permitting etc.
The Higher Corporation for Specialized Economic Zones ZonesCorp being
the EHS Regulatory Authority for the Industrial Sector in the Emirate of Abu
Dhabi, has established the Environmental, Health & Safety Regulatory
Framework Codes of Practice to communicate the requirements of EHS
management as a key factor in successful business development to all
industries within the Emirate of Abu Dhabi. ZonesCorp considers the
establishment of priorities, programmes and practices as vital for integrating
good environmental, health & safety management into all entities business.
The Industrial Sector EHS Regulatory Framework has been established in line
with the requirements of UAE EHS Laws, Regulations and the Abu Dhabi
(EAD) EHS Management System Framework Documents for the Industrial
Sector. The system is also aligned with other international standards like
ISO14001, OHSAS18001 and BS8800 for Occupational Health.

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2. SCOPE

This document is applicable to the all the Entities within Industrial Sector in
Abu Dhabi Emirate.
The Industrial Sector includes but is not limited to Entities in Abu Dhabi
Industrial Cities (ICADs), Al-Ain Industrial Cities (AAICs), Western Region
Industrial Complex, Mussafah Industrial Area and Workers Facilities (Labour
Camps) for Industrial Sector within Abu Dhabi Emirate.
This document applies to all work related EHS Incidents (including incidents
related to visitors and contractors) occurring at the facilities within Industrial
Sector in Abu Dhabi Emirate, including injuries related to work assigned
outside the facilities to the direct / contractor employees.
Wherever possible, and rather than providing detail within this document,
reference is made to other, more detailed documents that have been provided
in the ZonesCorp EHS Management System.
3. DEFINITIONS
3.1 Accident: An uncontrolled / unplanned / undesired / uncontrolled event that
results in undesirable consequences to the personnel (injuries/illness) and/ or
to the assets (damage/loss) or to the neighbouring community and/or to the
environment. The term Accident is synonymous with Incident wherever used
in ZonesCorp EHS Management Framework
3.2 Authorized Medical Physician/Surgeon: A medical physician or surgeon
appointed by the Entity for classification of injury/illness in accordance with
this document.
The Authorized Medical Physician/Surgeon may be on the payroll of the Entity
or a general practitioner and shall be familiar with these guidelines.
3.3 Charter: Scope of the incident investigation.
3.4 Chemical: Any organic/inorganic substance.
3.5 Concerned Entity: The Entity where the incident has occurred.
3.6 Contractor Employee: Personnel who are not on the payroll of the
concerned Entity, and are supplied by a third party (Contractor, sub-
contractor, consultants or vendors) to work at the Entity site on full or part-
time basis. All such employees whether they are to provide services or are
supporting any department/activity, whether they are under direct supervision
of Entity employees or are supervised by the Contractor employees shall be
considered as Contractor employees.
3.7 CoP: Code(s) of Practice
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3.8 Days Lost: All calendar days (including the scheduled days off such as
weekends, company holidays, vacation days or others off, etc.) on which an
employee is unable to work as a result of Lost Workday Injury (LWI) / Illness.
This does not include day of the injury / illness.
3.9 Direct Cause: The main cause that resulted in the incident/accident. The
event, situation or condition that resulted in the incident/accident.
3.10 EAD: Environmental Agency Abu Dhabi
3.11 EHS: Environment Health & Safety
3.12 EHSMS: EHS Management System
3.13 Entity: Facilities within Industrial Sector including Industrial, Commercial,
Residential and Welfare.
3.14 Entity Employee: All Personnel who are on the payroll of the concerned Entity
3.15 Entitys Premises: The whole area for the core business (operating plants
and off-site facilities supporting plant operations) of the Entity that may or may
not be fenced, including the Administration and other buildings in that area
excluding the Employees/Visitors car parking lots (injury while performing any
assigned work in Employees/Visitors car parking lots will be considered work
related).
3.16 Explosion: Instantaneous release of energy leading to a rapid increase of
pressure or causing a pressure wave and/or shock wave in a fluid medium.
3.17 Exposure Hours: These are the total number of hours of employment
including overtime and training but excluding leave, sickness and other
absences. Exposure hours may be estimated if necessary. Hours worked
must be in multiples of 1000, rounded to the nearest 1000.
3.18 Fatality: Death resulting from work related injury/illness.
3.19 Fatal Incident Rate (FIR): The number of fatal incidents per 100,000,000 (100
million) hours worked. Incidents involving a third party fatality are included,
provided they directly result from company or contractor operations.
3.20 Fire: Uncontrolled generation of flame.
3.21 First Aid Injury/illness: Any injury/illness that requires First Aid treatment only,
with no necessary follow up visit to the medical facilities. Refer to Appendix 2.
3.22 Hazardous Chemical/Substance: Any chemical/product/catalyst or waste
classified as such by national/local legislation (such as for the Abu Dhabi
Emirate, Chemicals that meet the Hazardous Material Classification of EAD).
3.23 Incident: An uncontrolled / unplanned/undesired / uncontrolled event that
results in undesirable consequences to the personnel (injuries/illness) and / or
to the assets (damage/loss) or to the neighbouring community and/or to the
environment. The term Incident is synonymous with Accident wherever used
in ZonesCorp EHS Management Framework
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3.24 Incident Classification:
a. Major Incident: EHS Incident that meets any of the criteria listed under
Major Incidents of the Incident Severity Assessment Guidelines
(Appendix-1). These incidents shall be classified as Major Incidents.
b. Serious Incident: EHS Incident that meets any of the criteria listed
under Serious Incidents of the Incident Severity Assessment
Guidelines (Appendix-1). These incidents shall be classified as Serious
Incidents.
c. Minor Incident: EHS Incident that meets any of the criteria listed under
Minor Incidents of the Incident Severity Assessment Guidelines
(Appendix-1). These incidents shall be classified as Minor Incidents.
3.25 Industrial Sector: Industrial Sector within Abu Dhabi Emirate includes but not
limited to Entities (Industrial Units etc.) in Industrial Cities developed by
ZonesCorp, Industrial Areas like Mussafah, Mafraq, etc. and Workers
Facilities (Labour Camps) for Industrial Sector
3.26 Long Term Contract Employees: Employees working in approved position
that appears on the Entity organization chart but are provided by contractor,
and employees who are required to report on every workday at the Entity site
to work under long-term contract (a year or more) for maintenance or to
provide other services (Maintenance, Technical, Administrative support,
Janitor, gardening, cafeteria etc.).
3.27 Lost Time Injury (LTI): A Lost Time Injury is the Fatality or Lost Workdays
Case. The total number of LTIs is the sum of Fatalities and Lost Workday
Cases. Refer 3.30 for definition of Lost Workday Cases.
3.28 LTI Frequency Rate (LTIFR): The LTI Frequency measures the number of
lost time injuries (LTIs) in the exposure period (reporting period) as a
percentage of the workforce.
It is calculated by multiplying the number of LTI (Fatalities + Lost Workday
Case) by 1,000,000 & dividing by the exposure hours worked during the
reporting period.
LTIFR = (No. of LTIs x 1,000,000) / Exposure Hours
3.29 LTI Severity Rate (LTISR): The LTI Severity Rate measures the number of
work hours lost due to Injuries in the exposure period (reporting period) as a
percentage of the workforce.
It is calculated by multiplying the work hours lost due to LTIs (by 1,000,000
and dividing by the exposure hours worked during the reporting period.
LTISR = (No. of Days lost x 1,000,000) / Exposure Hours
In cases of fatality or permanent total disability no lost workdays shall
be reported

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3.30 Lost Workday Case (LWDC)
A lost workday case is any work-related injury or illness which renders the
injured person (Entity Employee or Contractor) temporarily unable to
perform any regular job or restricted work activity on any normally
scheduled workday after the day on which the injury occurred.
Lost workday cases include permanent total disabilities, permanent partial
disabilities and lost workday cases resulting from work-related injuries.
A single accident can give rise to several lost workday cases, depending on
the number of people injured as a result of that incident.
Note: Restricted Work Cases & Medical Treatment Cases are not an LWC,
provided that the person can return to work (any work assigned) within his/her
normal working day.
3.31 LWDC Frequency: The LWDC Frequency measures the number of Lost
Workday Cases in the exposure period as a percentage of the workforce.
It is calculated by multiplying the number of LWC (Lost Workday Case) by
1,000,000 & dividing by the exposure hours worked during the period.
F = (No. of LWDC x 1,000,000) / Exposure Hours
3.32 LWDC Severity: Lost Workday Case Severity (LWDCS) is a measurement of
the seriousness of injuries and is the number of lost workdays (estimated
where necessary) per million exposure hours worked during the period.
S = (Lost Workdays x 1,000,000) / Exposure Hours
3.33 Lost Workdays: The number of lost workdays is the total number of
scheduled workdays on which the injured person was temporarily unable to
work as a result of a lost time injury.
In cases of fatality or permanent total disability no lost workdays shall
be reported.
In cases where employment is terminated, this would include any previously
scheduled workdays lost that were planned prior to the event, or an estimate
of workdays that would be lost after termination.
3.34 Man-hours Worked: The number of hours during which the employee (Entity
or contractor) is present in the work environment as a condition of his
employment.
3.35 Medical Treatment Injury/Illness: Any injury/ illness which because of its
severity requires treatment by a Physician or by a registered Medical
Professional under standing order by a Physician. Refer to Appendix 2.
3.36 Near Miss: All incidents that did not result in but have the potential to result in
undesirable consequences to personnel (injury/illness), and/ or to the assets
(damage/loss) or to the neighbouring community and environment.
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3.37 New Case: Only new cases are recordable. Work-related injuries and
illnesses are considered to be new cases when the employee has never
reported similar signs or symptoms before, or when the employee has
recovered completely from a previous injury or illness and workplace events
or exposures have caused the signs or symptoms to reappear. This shall also
include the work related physical stress
3.38 Occupational Injury: Physical harm to employee that resulted from single
exposure event to chemical, physical, or biological agents in the work
environment.
3.39 Occupational Illness: is any abnormal condition or disorder, other than one
resulting from an occupational injury, caused by exposure to factors associated
with employment and/or work environment. It includes acute and chronic
illnesses or disease that may be caused by inhalation, absorption, ingestion, or
contact. Example welding eye, cancer, tuberculosis, dermatitis etc.
3.40 Property Damage: All incidents (other than Fire or Explosion) that resulted in
damage to Entitys property caused by an accident (and not because of
normal wear and tear damages to the equipment). For example Damage of
floating roof of tank because of miss-operation, crane related incidents,
Forklift hitting and damaging an equipment etc.
3.41 Recordable Injury/Illness: Death or cases of occupational injuries or
illnesses that result in days away from work, days of restricted work, Loss of
consciousness, Temporary or permanent job transfer, termination of injured
employee or medical treatment beyond first aid.
3.42 Reportable Injury: Total reportable injuries is the sum of fatalities, permanent
total disabilities, lost time cases, and cases involving restriction of work or
motion, medical treatment or loss of consciousness. An injury may progress
from a lower category to a higher or more severe category. It shall be reported
in the higher category only. Refer to Appendix 2 & 3.

3.43 Restricted Work Injuries/Illness: Any injury/illness because of which the
employee is unable to perform one or more of the routine functions of his job
(job functions that the employee regularly performs at least once per week), or
from working the full workday that he would otherwise have been scheduled
to work, regardless of whether or not the employee is scheduled to work on
those day(s)
3.44 Restricted Work or Job Transfer Days: All scheduled workdays (excluding
the day of the injury/illness) on which an employee is unable to work part of his
routine assignments or is assigned a different job or is assigned to light duty as
a result of work related injury/illness.
The maximum number of Restricted Workdays or Job transfer days for a
single injury/illness should not be put more than 180 calendar days in the
incident statistics, even if the actual Restricted Work or Job transfer days are
more than 180
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3.45 Root Cause: The factor that started the chain of events, if removed, it
prevents recurrence of the same or similar incident.
3.46 Safe Man-hours: The number of Man-hours worked without a Lost Workday
injury/Illness or Fatality.
3.47 Self-Regulation is a concept designed to enhance protection of human
health and the environment by encouraging the regulated community to
voluntarily discover, disclose, correct, and prevent violations of relevant laws.
For the purpose of the EHSMS, self-regulation is defined as: Action
undertaken by entities to develop and implement an Environment, Health and
Safety Management System that complies with the laws and policies of the
Emirate of Abu Dhabi and international standards
3.48 Shall: The Term shall as used in this document is intended to describe
mandatory requirements.
3.49 Should: The term should is intended to designate optional or practices which
ZonesCorp does not consider mandatory, but does recommend that Entities
consciously evaluate any deviation from these recommended practices
3.50 Tenant: The Project Proponent/Lease Holder/Concession Agreement Holder/
Owner/Operator of an Entity within the Industrial Sector in Abu Dhabi Emirate
3.51 Total Reportable EHS Incidents Rate (TRIR): The number of reportable
injuries (fatalities + lost workday cases + restricted workday cases + medical
treatment cases) per 1,000,000 hours worked.
TRIR = (Total No. of Reportable Injuries x 1,000,000) / Exposure Hours
3.52 Total Days Lost Severity: Number of Total Days Lost because of Lost
Workday Cases per 1,000,000 Man-hours worked.
TS = (Total Days Lost x 1,000,000) / Exposure Hours
3.53 Vehicle incidents: These are incidents involving motorized vehicles designed
for transporting people and goods over land, e.g. cars, buses, trucks.
Pedestrians struck by a vehicle are classified as vehicle incidents. Incidents
from a mobile crane would only be vehicle incidents if the cranes were being
moved between locations.
3.54 Work Environment: Consists of the Entitys premises and other locations
where employees are engaged in work-related activities or are present as a
condition of their employment. The work environment includes physical
location as well as the equipment or material used by the employees.
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4. EXISTING APPLICABLE LAWS
All Tenants shall ensure that their operations comply with all relevant UAE
and Abu Dhabi Environmental, Health and Safety laws and regulations.
Environmental, Health and Safety regulations in the UAE are gradually being
implemented.
This Code of Practice has been developed to ensure compliance to or exceed
the requirements of all relevant legislative statutes and regulations,
specifically including but not limited to:
4.1 Federal EHS Laws and Codes including UAE Standards Industrial Safety &
Health Regulations (Emirates Authority for Standardization & Metrology)
4.2 Local Law No. ( ) of 2008 concerning Environment Health & Safety
Management System in Abu Dhabi Emirate
4.3 Local Law No. 16 of 2005; Article 14 Establishment or Individual is prohibited
to carry out any activity that could adversely affect the lives of human beings
and the safety of the environment before obtaining a license from the Agency.
4.4 Local Law No. 21 of 2005 on the Waste Management in Emirate of Abu Dhabi
4.5 Local Law No. 23 of 2005 and the Executive Regulations Regarding the
Health Insurance Scheme for the Emirate of Abu Dhabi
4.6 Federal Law No. 1 of 2002 Regarding Organisation & Monitoring the Use of
Radiation Resources and Protection
4.7 Federal Law No. 8 of 1980. The Labor Law (as amended 1986)
4.8 Federal Law No. 23 of 1999 Marine Bio-Resources in the UAE
4.9 Federal Law No. 24 of 1999 for the Protection & Development of the
Environment
4.10 Regulations / Executive Orders made under the Federal Environment Law
a. Federal Bylaw; Protection of Air from Pollution (Ministerial Order # 12 of
2006)
b. Federal Bylaw; System for Protected Area
Ministerial Decree No. 37 of 2001 concerning the approval of the Executive
Orders for Law No. 24. It includes the following Regulations:
c. Environmental Impact assessment of Projects 2001
d. Assessment of Environmental Effects of Installations 2001
e. Protection of the Marine Environment 2001
f. Handling Hazardous Materials, Hazardous Wastes & Medical Wastes 2001
g. Pesticides, Agricultural Additives and Fertilizers 2001
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4.11 Ministerial Decrees & Decisions:
a. Decree No. 50/2003 Basic Regulating Rules for Ionizing Radiation
Protection
b. Decree No. 55/2004 Basic Regulations for Protection against Ionizing
Radiation.
c. Decree No. 56/2004 Basic Regulations for Safe Transport of Radioactive
Materials
d. Decree No. 57/2004 Basic Regulations for Radioactive Waste Management
e. Decree No. 214/2004 on Use of Sludge on Land
f. Ministerial Order No.32/1982 on the Determination of Preventative
Methods and Measures for the Protection of Labor from Risks at Work
4.12 Abu Dhabi Emirate Environment Protection Policies (EEPPs)
a. Part 1 Air Quality
b. Part 2 Water Quality
c. Part 3 Land Quality
d. Part 4 Noise
e. Part 5 Waste
f. Part 6 Hazardous Substances
g. Part 7 Occupational and Environmental Health & Safety
h. Part 8 Biodiversity and Conservation
4.13 Abu Dhabi Emirate Environment Protection Policies Standards
a. Part 1 Air Quality Standard
b. Part 2 Water Quality Standard
c. Part 3 Land Quality Standard
d. Part 4 Noise Quality Standard
4.14 Abu Dhabi Emirate EHS Management System Codes of Practices
a. Self Regulation
b. Roles & Responsibilities
c. Risk Management
d. Audits & Inspection
e. Emergency Management
f. Monitoring and Reporting
g. Management Reviews
4.15 EAD Regulations on Hazardous Material & Waste Permit
4.16 Industrial Safety and Health Regulations Occupational Health and
Environmental Control SSUAE No. 209 / 1995.

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5. RESPONSIBILITIES
5.1 Competent Authority
The Competent Authority (EAD) in cooperation with the Regulatory Authority
(ZonesCorp) shall approve the types of entities (targeted entities) that should
develop & implement an EHSMS in accordance with the Abu Dhabi Emirate
EHS Law.
The Competent Authority (EAD) shall set mechanisms for:
Reviewing and approving EHSMS developed by Entities to ensure
compliance with the requirements of the EHSMS at Abu Dhabi Emirate
level.
Auditing the EHSMS implemented by different entities.
The Competent Authority (EAD) shall promote the importance of
implementing the EHSMS.
The Competent Authority (EAD) shall be responsible for reporting to the
Executive Council the performance of the EHSMS at Abu Dhabi Emirate level.
5.2 Regulatory Authority
Regulatory Authority shall administrate, advise and support the EHSMS
Framework of Industrial Sector
The Regulatory Authority (ZonesCorp) in cooperation with the Competent
Authority (EAD) shall:
Develop Industrial Sector EHS Policy and Establish EHS Regulatory
Framework including Codes of Practice & Guidelines
Identify the types of entities that should develop & implement an EHSMS
in accordance with the Abu Dhabi Emirate EHS Law
Review and approve EHSMS developed by entities in compliance to the
requirements of the Abu Dhabi Emirate EHSMS.
Audit the EHSMS implemented by different entities.
Receive EHS Performance from Industrial Sector Entities
Compile and report EHS Performance of Industrial Sector to the
Competent Authority (EAD)
Promote the importance of implementing the EHSMS
5.3 Entities
5.3.1 Entities shall develop and implement an EHSMS within their areas of
jurisdiction to protect their employees, the community and the environment
from any adverse impacts arising from their activities.
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5.3.2 Entities shall provide and maintain a safe environment for workers, avoid any
risk to human health, avoid adverse impact to environment and prevent
environmental pollution.
5.3.3 Entities having an EHSMS are required to audit their System in order to
ensure conformance with ZonesCorp EHSMS Requirements.
5.3.4 Entities having established an EHSMS are required to demonstrate self
regulation
5.3.5 Entities having an EHSMS are required to submit an annual report to the
ZonesCorp / EAD on the performance of their System as per the mechanism
set by ZonesCorp.
5.4 Employers Duties
5.4.1 Employers have the ultimate responsibility to ensure the health and safety of
their employees.
5.4.2 Employers have a general Duty of Care to take all practicable steps to ensure
the safety of their employees while at work, visitors and contractors.
In particular, they are required to take all practicable steps to:
Provide and maintain a Safe Working Environment;
Provide and maintain facilities for the Safety and Health of employees at
work;
Ensure that machinery and equipment are safe;
Ensure that working arrangements are not hazardous to employees; and
Ensure a Safe System of Work comprising at least of Procedure, Training,
Communication & Supervision is in place
Ensure procedures are available to deal with emergencies that may arise
while employees are at work.
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6. REQUIREMENTS
The Entities in the Industrial Sector shall develop procedures and programs
that meet the requirements outlined in this document on EHS Incident
Reporting, Classification, Investigation and Analysis:
All the requirements of this document shall be applicable in totality to Workers
Residential Cities and Labour Camps within Industrial Sector of Abu Dhabi
Emirate.
ZonesCorp HSE Division shall be consulted for any clarifications to this
document. The clarification given by ZonesCorp shall be complied with and
considered final.
6.1 INCIDENT CLASSIFICATION:
6.1.1 EHS Incidents shall be categorized into one of the following categories using
the Incidents Severity Assessment Guidelines (Appendix-1):
a. Safety
b. Health
c. Environment.
6.1.2 The classification of the EHS incident shall be based on the Severity. as one
of the following by considering the most serious consequences of the incident
using the Incidents Severity Assessment Guidelines (Appendix -1).
a. Major
b. Serious
c. Minor
Best judgment shall be made to classify the EHS incidents for initial
reporting. The EHS incident classification may be revised during/after
investigation:
6.1.3 Appendix 1 provides criteria for Incidents Classification based on the Incident
Severity. For the purpose of Reporting the below listed definitions shall be
followed:
a. Major Incident which are resulted in Major or Catastrophic
Consequence
b. Serious Incident which have been resulted in Moderate Consequence
c. Minor Incident which have been resulted in Insignificant or Minor
Consequence
6.1.4 EHS incidents shall be reported as one of the following Incident Types.
a. Occupational Injury / Illness
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b. Fire / Explosion
c. Property Damage
d. Chemical / Oil Spill or Release (not causing any contamination as listed in
h, i & j below)
e. Vehicles
f. Off Specs Air Emission
g. Off Specs Waste Water Release
h. Contamination of any Free Flowing Channel including Sea / Canal / River /
Storm Water / Rain Water etc.
i. Ground Water Contamination
j. Soil Contamination
k. Damage to Flora & Fauna (including animals, marine insects, trees, plants,
mangroves etc.)
l. Noise
m. Uncontrolled Radioactivity Release
n. Near miss
6.1.5 If injuries/illness occurred as a result of any incident of the type as listed
above then the incident that caused the injury or illness shall be selected for
defining the type of Incident.
For example, if the injury/illness is caused by Fire, Explosion or Chemical
release incident then the type of incident shall be defined based on the cause
of the incident i.e. Fire, Explosion or Chemical release incident rather than
Injury / Illness incident.
6.1.6 Occupational Injury/Illness shall be further classified into following categories;
where a to d are classified as Recordable injuries:
a. Fatality.
b. Lost Workday
c. Restricted Workday
d. Medical treatment
e. First Aid
6.1.7 Decision regarding the type and classification of injury/illness shall be made
by a Medical Physician/Surgeon (Authorized/approved by the concerned
Entity) in consultation with the concerned Entitys EHS Department / Staff.
Appendix 2 provides guidelines for Injury/Illness Classification.
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6.2 ESTABLISHING WORK-RELATIONSHIP
6.2.1 Work-relatedness is presumed for injuries and illnesses resulting from events
or exposures occurring in the work environment. Appendix 2 & 3 provides
guidelines about establishing work relationship for an injury/illness
6.2.2 A case is presumed work-related if an event or exposure in the work
environment caused or contributed the injury or illness or of a significant
aggravation to a pre-existing condition.
6.2.3 A case is not recordable if it involves signs or symptoms that surface at work
but resulted from a non-work-related event or exposure that occurred outside
the work environment.
6.2.4 If it is not obvious whether the event or exposure occurred in the work
environment or elsewhere, the employee's work duties and environment shall
be evaluated to decide whether or not one or more events or exposures in the
work environment caused or contributed to the resulting condition or
significantly aggravated a pre-existing condition. Refer to section 5.3.
6.2.5 For any situation where the work relationship is not clearly understood
through the guidelines (Appendix 2 & 3), interpretation of ZonesCorp HSE
shall be obtained and considered final
6.3 INCIDENT REPORTING:
6.3.1 An incident reporting system and procedure shall be in place that encourages
Employees, Contractor employees and Visitors to report EHS Incidents.
6.3.2 All Entities (Industrial Units, Residential and Commercial facilities) shall follow
this document for incident Reporting, classification, investigation and Analysis
during Design, Construction & Operation phase.
6.3.3 Facility Operators within Workers Residential Cities and Labour Camps shall
be responsible for establishing the procedure in line with the requirements of
this document.
6.3.4 Any clarification if necessary can be obtained from ZonesCorp HSE however
all the requirements of this document shall be applicable in totality to workers
residential cities and labour camps within Industrial Sector of Abu Dhabi
Emirate.
6.3.5 Every EHS incidents including injuries/ illnesses to the contractor employees
and visitors shall be reported.
6.3.6 The information contained in the ZonesCorp EHS Incident Notification Form
(ZC-COPEHS02-F001) as given attachment to this document shall be, as a
minimum, included in the Entity Incident Reporting form.
6.3.7 EHS Incidents shall be immediately notified to the concerned area supervisor
or equivalent.
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6.3.8 Best judgment shall be made to classify the EHS incidents based on the
Severity of the incident (appendix 1, 2 & 3) for initial reporting. The incident
classification may be revised during/after investigation.
6.3.9 All Major and Serious EHS Incidents shall be reported to the Concerned
Entitys EHS Manager or equivalent, immediately.
EHS Incidents shall be reported to ZonesCorp HSE Division (Contact
numbers in Appendix 5) as per the following guidelines:
Major Incidents Verbal Immediately
Written Within 12 hours after
declaring the emergency over
Serious Incidents Verbal Not required
Written within 24 hours of the
accident occurred
Minor Incidents Verbal Not required
Written After completion of
investigation for those incidents that
have high learning value or as
deemed necessary by ZonesCorp.
6.3.10 Entities shall report each incident in accordance with the Severity
determination guidelines (Appendix 1). In the event where an incident fits
both the Safety and the Environmental guidelines, a separate report shall be
issued for each category.
6.3.11 ZonesCorp HSE Manager shall inform the Major EHS Incidents to the
CEO, who will communicate the incidents to the ZonesCorp Executive
Management and other Governmental Authorities as deemed necessary
6.3.12 Written EHS Incidents reports by the Entities shall be on the Incident
Notification Form (ZC-COPEHS05-F001) as given in this document.
6.3.13 ZonesCorp EHS Division shall establish a system for compiling the EHS
Major & Serious Incidents reports information for distributing to Industrial
Sector Entities as deemed necessary.
6.3.14 The concerned Entity is responsible to communicate the following types of
occupational injuries involving the Medical Cost and Days Away from Work
to concerned insurance agencies, Ministry of Labour and other
Governmental Departments as required by the applicable laws and
regulations: The reporting shall be on forms as prescribed by the concerned
agency.
a. All injuries/fatalities occurring at the Workplace.
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b. Injuries/fatalities occurring during Company Business Trips
c. Injuries/fatalities occurring on the way to work place from home or vice-
versa.
6.3.15 The Entities shall be responsible for maitaining and updating themselves
with the latest requirements of various UAE Laws and regulations
6.4 INCIDENT INVESTIGATION:
This section and Appendix 4 provides the basic guidelines for Accident
Investigation including details about Loss Causation Model, Root Cause,
Basic Cause, Controls etc.
6.5 IMMEDIATE ACTION FOR INVESTIGATION
a. Every EHS incident including injuries/illnesses to contractor employees
and visitors requiring Team investigation shall be investigated as per the
requirement given in this section.
b. After an incident is declared over, appropriate steps shall be taken to
preserve the evidence. No material shall be removed from the site of the
incident unless authorized by the investigation team leader.
c. Immediately after the incident, the Concerned Area Supervisor shall
barricade the area, gather charts and data, obtain written statements of
personnel who were working in the area or were witness to the incident,
obtain copies of the logged reports and log sheets, gather copies of
relevant plant operations parameters and trend charts, take photos, etc.
and make a preliminary assessment of cause and effect.
d. These shall be handed over to the investigation Team Leader once he is
appointed by the Appointing Authority. Only personnel authorized by the
Appointing authority or government authorities (as required by local
regulations for investigation) and investigation Team members should be
permitted to enter into the barricaded area. Barricade should be removed
after Investigation Team / Government authorities have gathered the
required evidence / information.
e. All personnel shall be instructed to avoid visiting the incident site, until
cleared by the investigation Team Leader.
f. The Appointing Authority shall assign personnel to an Investigation Team
and a Repair and Recovery Team as appropriate.
g. The Investigation Team for Major and Serious incidents shall be
formed as soon as possible after the emergency is declared over. The
Team shall initiate investigation within 48 hours after the emergency is
declared over.
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h. All EHS incidents reported to ZonesCorp and other Governmental
Authorities shall be investigated
6.6 APPOINTING AUTHORITY
6.6.1 The Senior Management (Division Manger or above) of the concerned Entity
(where the incident occurred) shall be the appointing authority for all Major
Incidents.
6.6.2 The Department Manager (or equivalent) of the area where the incident
occurred shall be the appointing authority for all Serious incidents.
6.6.3 The Section Head (or equivalent) or higher position of the concerned
department in the Entity (where the incident occurred) shall be the appointing
authority for all Minor incidents that in his judgment requires a Team
Investigation.
6.6.4 The events leading to the Minor incidents are generally clear and do not
require a full team to examine root cause and prevention measures. The
Incident Notification form often contains sufficient details to take action
towards prevention.
6.6.5 The Appointing Authority shall appoint the Investigation Team Leader and the
Investigation Team.
6.7 INVESTIGATION TEAM
6.7.1 Investigation Team shall be formed based on the initial assessment of the
classification of the Incident. Team shall not be changed even if during the
course of the investigation it is established that initial classification was not
correct.
6.7.2 For all Major & Serious EHS incidents, a trained Investigation Team
Leader (who should not be from the department where the incident occurred)
from the concerned Entity shall lead the investigation team. The team shall
comprise of appropriate members from the concerned Entity including
representative(s) of the Entitys EHS Department.
6.7.3 For Major EHS Incidents, representative(s) from ZonesCorp HSE Division
shall be part of the investigation Team.
6.7.4 For Serious EHS incidents, representative(s) from ZonesCorp HSE Division
shall be part of the Investigation Team, if deemed necessary.
6.7.5 For Minor EHS incidents, the First Line Supervisor (or equivalent) of the
Entitys concerned department is responsible to investigate the incident. He
should seek help of other professionals from the Entity to investigate the
incident, if required.
6.7.6 The concerned Section Head or equivalent (where the incident occurred) may
form an Investigation Team and appoint a Leader (may be other than the
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concerned area first line supervisor or equivalent) for those Minor incidents
that in his judgment requires a Team Investigation.
6.7.7 The investigation Team Leader shall have received formal training on incident
investigation procedure and technique used by the Entity for incident
investigation and Analysis.
6.7.8 A First-Line Supervisor and/or Section Head (or equivalent) of the Area where
the incident occurred shall be included in the investigation team.
6.7.9 Team size shall be at the discretion of the Appointing Authority and should
recognize specific skills that may be required (e.g. Operations, Safety /
Environment, Control Systems, Engineering Support, and Maintenance).
6.7.10 Members should be selected in consultation with the Team Leader. Member
should be selected to represent various skills and large team sizes (i.e. more
than 8) should be avoided.
6.7.11 Contractor representative shall be included in the investigation team if a
Contractor employee is involved in the incident.
6.7.12 Members of the Investigation Team shall be expected to continue the
investigation without interruption from other activities, e.g. vacation, training
classes, other work priorities.
6.7.13 The Appointing Authority shall define the Teams charter, including preliminary
completion date and any constraint on making recommendations that are not
directly related to immediate cause or root cause prevention.
6.8 INVESTIGATION
6.8.1 Team investigation shall be carried out for all Major & Serious incidents.
Team investigation shall be carried out for those Minor incidents that in the
judgment of Appointing Authority requires Team Investigation.
6.8.2 The Investigation Teams mission is to identify what caused the incident and
to determine the effectiveness of response of Emergency Teams and
Production personnel (if applicable).
6.8.3 The Team should make recommendations to prevent occurrence of similar
incidents and improve Emergency response and plant operational response (if
applicable).
6.8.4 The Investigation Team shall be separate from the Repair and Recovery
Team, and should avoid recommendations related to return to normal
operations.
6.8.5 The Appointing Authority should work closely with both teams so that any
finding can be incorporated into the task of either group.
6.8.6 The incident investigation Leader for Team investigation shall ensure that all
preparations for the investigations have been completed. He should fill-in the
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Incident Investigation Leaders Preparation Checklist Form ZC-COPEHS05-
F002 as given in this document.
6.8.7 Interviews should be conducted of all potential witnesses/affected personnel
as soon as possible after the formation of investigation team. Written
statements taken earlier should be the basis of interviews and to seek further
information and clarifications.
6.8.8 While taking the written statement, witnesses should be isolated as much as
possible to minimize intermingling of information. Incident Witness Statement
Form (ZC-COPEHS05-F003), as given in this document, should be used to
record statements.
6.8.9 Interview of each witness/affected personnel should be conducted separately
and should be relaxed, receptive, objective and adaptable so as not to
intimidate the witness. Written statement of each interview shall be prepared
and recorded. The Incident Interview Notes / Checklist Form ZC-COPEHS05-
F004 as given in this document should be used for this purpose.
6.8.10 Analyze the witness testimony for credibility. Validity of testimony depends
upon the investigators skill in extracting the evidence and validating the
evidence to remove the human error element.
6.8.11 Wherever appropriate, prepare diagrams and maps of the incident scene
that include the exact location of people, equipment and facilities. Accurate
measurements are essential for an effective investigation.
6.8.12 Prepare a diagram (chronological time line) which outlines the sequence of
events leading up to the incident and up to control of the incident Include the
specific times of each sequence, indicating direction & precise reference
points
6.8.13 Re-enactment of an incident should be considered if information about the
actions or sequence of events cannot be obtained, if precise step-by-step
observations are needed to develop preventive remedial actions, and if the
key facts from witnesses are in conflict and need to be verified for analysis.
Consider the following for re-enactment:
a. Re-enactment of an incident should be well planned and supervised to
prevent repetition of a loss or the creation of an incident from a near-miss
b. Identify potential hazards specific to the re-enactment.
c. Identify possible consequences specific to the activity.
d. Establish specific precautions for the re-enactment activity.
e. Ensure all involved understand the hazards and precautions.
f. All steps shall be verbally discussed and agreed by the concerned
Area Manager (or equivalent) and the investigation Team Leader prior
to the actual physical actions being performed.
g. The final step that led to the actual incident shall not be repeated.
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6.8.14 The Investigation Team shall review incident report(s) of previous similar
incidents, where available.
6.8.15 The Investigation Team shall follow an appropriate incident investigation
technique such as Causal Factors, Tripod, Fault Tree, Root cause etc to
analyze the cause of the Incident. Refer to Appendix 4 Loss Causation
Model
6.9 TIMINGS FOR COMPLETION OF REPORTS
6.9.1 PRELIMINARY REPORTING
a. The Investigation Team Leader should issue a written or verbal preliminary
Investigation Report to the Appointing Authority within the first 48 hours
after the Investigation Team is formed, for all the incidents requiring Team
investigation.
b. The preliminary reporting should describe the incident summary, process
of investigation, data gathered and immediate actions to be taken to make
the area safe before resuming normal activities. Form ZC-COPEHS05-
F005 as given in this document is a suggested format for the Preliminary
Investigation report.
6.9.2 FINAL INVESTIGATION REPORTS
a. The Final Report for All incidents requiring Team investigation shall be
issued within 30 calendar days after the incident.
b. The Final report of those Minor incidents that do not require Team
investigation shall be issued within 7 working days after the incident. The
Final report for such Minor incidents shall as a minimum include the
information contained in the Incident Investigation Summary Report Form
ZC-COPEHS05-F006 as given in this document.
c. Incident Analysis shall be carried out for each incident. The Incident
Analysis form shall be developed by each Entity. The Incident Analysis
Form ZC-COPEHS05-F007 as given in this document should be used for
this purpose.
d. The Investigation Team Leader shall ensure that the Incident Analysis
Form is filled and made part of the investigation report.
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6.10 CONTENT OF FINAL INVESTIGATION REPORTS
The main body of the Final Investigation Report should be limited to three (3)
typewritten pages to allow the reports to focus on description, direct cause,
root cause(s), and recommendations.
More detailed information such as process schematics, time lines, analyses,
pictures, supporting evidence, etc., should be attached as necessary.
A typical outline of the Final Investigation Report shall follow a format similar
to given below:
a. Executive Summary.
b. Description of Incident (Narrative).
c. Observations and Evidence (Brief Analysis).
d. Conclusions.
e. Recommendations.
f. Other Observations.
g. Appendix to the Report: The following should be considered to be part of
Appendices of the report depending upon the nature of incident:
Duly filled Initial Incident Notification Report ZC-COPEHS05-F001 as
given in this document.
Duly filled Incident Investigation Team Leaders Preparations Checklist
ZC-COPEHS05-F002 as given in this document.
Duly filled Incident Witness Statement Form ZC-COPEHS05-F003 as
given in this document.
Duly filled Incident Interview notes/Checklist Form ZC-COPEHS05-
F004 as given in this document.
Duly filled Incidents Preliminary Investigation Form - ZC-COPEHS05-
F005 as given in this document.
Duly filled Incident Investigation Summary Report ZC-COPEHS05-
F006 as given in this document
Duly filled Incident Analysis Form ZC-COPEHS05-F007 as given in this
document.
Cause-Effect Analysis.
Schematics.
Time Lines or Sequence of Events.
Evidence Sorting.
Photographs.
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Copies of log sheets and logbooks.
Causal Factors/Tripod/Fault Tree/Root cause etc. Analysis Chart for
the incident.
Others.
6.10.1 Executive Summary shall contain a concise summary of what happened,
conclusions about causes, and key recommendations to eliminate or
minimize recurrence.
6.10.2 Description of Incident shall give a narrative explanation of the incident in
more detail, including sequence of events. This includes the status of the
unit, key time, events leading up to the incident, the extent of the incident
including cost impact, and any other factors that would help the reader to
understanding the incident.
6.10.3 The Observations and Evidence shall clearly state the evidence related to
the conclusions about cause and effect, and provide some analysis or
discussion of the links.
6.10.4 The conclusions shall state the investigation teams summary of what
happened and why. Conclusions shall be based upon the results of the
analysis. It shall include all direct and root causes. This may be in the form
of a most probable scenario, based upon the weight of evidence, when a
clear link between cause and effect is not established.
6.10.5 The Investigation Team shall review their findings (conclusions, root causes,
etc.) with the Appointing Authority. If the Team feels they do not have the
specialized knowledge to proceed with detailed corrective action and
Recommendations, they shall advise the Appointing Authority. If in
agreement, the Appointing Authority shall develop an alternative approach.
The intent is to avoid unnecessary work by the Team and/or by specialty
groups who may be involved with implementation of correction actions.
6.10.6 Recommendations shall state corrective actions for the root causes, and
shall clearly relate to the causes.
6.10.7 If a recommendation requires plant changes/modifications then procedural
control shall be recommended/ implemented to meet the intent of the
recommended plant changes/modification till required modification is
implemented.
6.10.8 Also, periodic follow-up of the procedural controls shall be recommended till
the plant changes/modifications are implemented.
6.10.9 The recommendations shall be made to integrate lesson learned from the
incidents into training & operating procedures, as applicable.
6.10.10 Recommendations should avoid general philosophical statements that apply
to the entire organization. Recommendations should clearly state the
corrective actions and shall be directly related to the defined cause(s). They
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shall answer the questions, If we do this recommendation, will future
incidents of this type stop?
6.10.11 The Investigation Teams recommendations shall not identify specific people
and timetables for implementation. It is the Appointing Authoritys
responsibility to evaluate the recommendations, to seek the appropriate
agreements on resources and target dates, and to develop the plan.
6.10.12 Other Observations shall identify those issues that do not necessarily relate
to the causes of the incident, but are important items that the Investigation
Team notes during its activities.
6.10.13 Once the investigation is complete, the Incident Analysis shall be carried out
for all Major, Serious and Minor Incidents. Form ZC-COPEHS05-F007 as
given in this document should be used for this purpose.
6.11 DISTRIBUTION OF THE FINAL INVESTIGATION REPORT
6.11.1 Draft of Investigation report shall be discussed between the Investigation
Team Leader, Concerned Area Manager/Section Head and Appointing
Authority.
6.11.2 The Final Investigation report with appropriate attachments from the
appendix (as decided by the Team Leader/Appointing Authority) shall be
distributed to all the concerned departments within the Entity.
6.11.3 The original copy of the EHS incidents Final Investigation report with all the
appendices shall be issued to the Entity EHS Manager.
6.11.4 A copy of the Final Investigation Report with all the appendices and a
Summary of incident investigation on Incident Investigation Summary
Report Form ZC-COPEHS05-F006 as given in this document shall be
issued to ZonesCorp HSE Manager.
6.11.5 The results of the investigation shall be reviewed pro-actively with the
affected personnel. The Incident Investigation summary report Form ZC-
COPEHS05-F006 as given in this document contains the minimum
information required for investigation sharing with all the affected
employees.
6.11.6 ZonesCorp HSE Division shall establish a system for compiling the
information received form the Entities through EHS Incident Reports (Major
& Serious) and prepare a consolidated report for distribution among the
Entities within the Industrial Sector in Abu Dhabi Emirate
6.12 FOLLOW-UP ON FINAL INVESTIGATION REPORT RECOMMENDATIONS
6.12.1 The Appointing Authority shall assign responsibilities and target dates to
implement recommendations.
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6.12.2 Management of change (MOC) procedures shall be followed for
recommendations requiring changes.
6.12.3 The Appointing Authority shall issue the approved recommendations with
responsibilities for implementation and target dates to the personnel
responsible to implement the recommendations and to the Entitys EHS
Department.
6.12.4 Changes in the target dates for recommendation implementation shall only
be done on the written approval of the Appointing Authority. The approved
changes in the target dates along with the justification shall be issued to the
Safety section for record.
6.12.5 A System shall be established to issue status reports on a quarterly basis to
the Appointing Authority and Entitys EHS Dept. until all action items are
completed. Status summary shall be issued to the Senior Management,
periodically.
6.12.6 ZonesCorp HSE Division may randomly verify the status of Major &
Serious Incidents Investigation Reports Recommendations and Follow-up
action taken.
6.13 INCIDENT STATISTICS AND ANALYSIS:
6.13.1 Actual Man-hours worked in a month calculated through timesheets shall be
used for calculations of Safe Man-hours and for Annual Man-hours worked
for Incident record purposes. Entities shall develop a system for accurate
calculation of Man-hours for employees and contractors.
6.13.2 Record of injuries to the contractors and visitors shall be maintained.
However, statistics of work related injuries/illnesses within the Entitys
premises to Long Term contractor employees, injuries to contractor
employees who come for short duration but are required to obtain work
permit to carryout the assigned task, and injuries to Product shipment
contractor employees (drivers and assistants) who come for
loading/unloading raw material or product shall ONLY be included in the
Contractor Employees Incident Rates. Man-hours of such contractor
employees shall be recorded and used to calculate Incident rates of
Contractor employees.
6.13.3 Exceptions: Injuries occurring at the Entitys premises to the following
contractor employees shall be reported and investigated. However, Man-
hours of these contractor employees should NOT be recorded and injury
statistics should not be used to calculate Incident Rates. Refer to Appendix
3 for guidelines about establishing work-relationship
a. Mail and courier personnel.
b. Office equipment service personnel.
c. Incidental delivery service personnel (e.g. convenience store deliveries,
vending machine deliveries, Incoming material deliveries).
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d. Casual visitors (e.g. Customers, Govt. Officials, Suppliers, Public
Officials, Tours).
6.13.4 If an employee/trainee of an Entity receives injury in another Entity (within
Abu Dhabi Emirate) while on visit or training then the injury will not be
recorded in the EHS Incident Statistics of the Entity where the injury was
reported instead it will be recorded in the EHS Incident Statistics of the
Entity of the employee / trainee.
6.13.5 However, in case of injuries to the employees that are Seconded to
another Entity then the injuries and the Man-hours shall be recorded in the
EHS Incident statistics of the Entity where the incident occurred
6.13.6 The maximum number of calendar days counted for Day Lost for a single
Lost Workday Injury/illness, Restricted Workday injury / illness shall be 180,
even if the employee does not start his normal duty after 180 Workdays.
6.13.7 The Day Lost should not be carried over to next year. Estimate of Day
Lost is to be made and entered in December EHS Incident Statistics Report
(Form ZC-COPEHS05-F008). However, the incident statistics report (Form
ZC-COPEHS05-F008) is to be revised later and issued to ZonesCorp HSE
Division, if the actual days are less or more.
6.13.8 In case of more than one Lost Workday Injury/illness and/or Restricted
Workday injury /illness as a result of an accident then Days Lost for each
injury/illness shall be individually counted and recorded in the statistics. The
maximum number of calendar days counted for each injury/illness shall not
be more than 180.
6.13.9 Man-hours & Days Worked since the last Lost Workday Injury/illness for
the Entity employees and Contractor employees shall be maintained at each
facility.
6.13.10 Monthly and Annual Incident Statistics shall be maintained by each
Entity. The statistics shall also include the following for reporting purpose;
refer to section 3 for definitions of each.
a. Man-hours Worked (Exposure Hours) since last LTI
b. Number of Lost Time Injuries (LTI) in the Reporting Period
c. Number of Hours Worked (Exposure Hours) in the Reporting Period
d. LTI Frequency Rate (LTIFR),
e. Number of Days Lost due to LTIs in the Reporting Period
f. LTI Severity Rate (LTISR)
g. Total Reportable EHS Incident Rate (TRIR),
6.13.11 Number of injuries/Illnesses rather than the number of injury/illness incidents
shall be taken to calculate the Incident Rates.
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6.13.12 Incident statistics: By the 5th working day of each month, Incident
statistics for the Entity along with the injuries records of Entity
employees/Contractor employees shall be issued to ZonesCorp HSE
Division on Incidents Statistics Report (Form ZC-COPEHS05-F008).
Electronic copy of Form ZC-COPEHS05-F008 can be obtained from
ZonesCorp HSE.
6.13.13 Incident Analysis:
a. Before the 15th working day of February each year Annual analysis
(based on Form ZC-COPEHS05-F007) of all the EHS incidents that had
Team Investigation in the previous year shall be carried out to find out
the common causes of the incidents.
b. The analysis of Contractor employees Incident Records shall also be
carried out to find out common causes and areas of concerns.
Recommendations shall be made to alleviate common causes and
concerns. Responsibilities shall be assigned and targets set to
implement the recommendations.
c. The Entity EHS section/department (or equivalent) shall be responsible
to make status reports quarterly to the line management and Senior
Management on all the recommendations of the EHS Incident Analysis
until all action items are completed. The analysis of EHS Incidents shall
be issued to the ZonesCorp HSE Division before 1
st
of March each
year.
6.13.14 EHS Incident Statistics as required by this standard shall be maintained
during the design and construction phase for all new and expansion
projects. The concerned entity/project management shall ensure that the
required statistics is issued to the entity HSE Manager.
6.13.15 ZonesCorp HSE Division shall annually carryout analysis of all the EHS
incidents (based on monthly and Annual reports - Appendix 5, issued by the
Entities) that have been recorded within Entities, and issue the report to all
concerned. This shall be in line with ZonesCorp CoP on EHS Performance
Monitoring & Reporting (CoP-EHS06)
6.14 RECORD-KEEPING:
6.14.1 Statistics of each category and class of EHS incidents as given in Section
6.1 (Incident Classification) shall be kept by the Entity EHS department for
the life of the plant.
6.14.2 The Original copy of the Initial Incident Notification Form and Final
Investigation Reports of all Major EHS incidents with all the appendices
shall be kept for at least 5 years. This file shall include notes, drawings,
photographs, testimony, and other data or information that was generated
during the investigation.
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6.14.3 The Initial Incident Notification Form and investigation reports of Minor &
Serious EHS Incidents shall be kept for at least 3 years.
6.14.4 The Incident Investigation and Incident Analysis recommendations reports
and all updates on recommendation follow-up status shall be maintained as
per Section 6.10 & 6.11
6.14.5 EHS Incident Analysis of each year shall be kept by the Entity (EHS
department) for at least 5 years.
7 REFERENCES
7.1 Abu Dhabi Emirate EHS Management System Manual
7.2 ZonesCorp Code of Practice on EHS Management System Framework
7.3 ZonesCorp Code of Practice on EHS Management Systems
7.4 ZonesCorp Code of Practice on EHS Performance Monitoring & Reporting
7.5 ZonesCorp Code of Practice on EHS Compliance Enforcement
7.6 ZonesCorp Code of Practice on EHS Impact Assessment (EHSIA)
7.7 ZonesCorp Code of Practice on EHS Risk Management
7.8 ZonesCorp Code of Practice on Integrity Assurance & Management
7.9 ZonesCorp Code of Practice on EHS Management of Contractors
7.10 ZonesCorp Code of Practice on EHS Audits and Inspections
7.11 EHS Management System Framework for Abu Dhabi Emirate
7.12 Occupational Safety & Health Administration (OSHA) Recordkeeping
Handbook (OSHA 3245-09R 2005)
7.13 International Association of Oil & Gas Producers (OGP) Health & Safety
Incident Reporting System Users Guide, 2006 Data Report No. 386 January
2007




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APPENDIX 1: EHS INCIDENT SEVERITY ASSESSMENT GUIDELINES
MINOR SERIOUS MAJOR
Area impacted
Insignificant
Consequences
Minor
Consequences
Moderate
Consequences
Major
Consequences
Catastrophic
Consequences
ENVIRONMENT
Land-based ecosystem Insignificant
environmental
impact.
Occasional
damage by
erosion, or of flora
and fauna. Some
disruption to flora
or fauna habitats.
Minor impacts on
fauna/flora and
habitat, but no
negative impacts
on ecosystem
function. Limited
damage to a
minimal area of
land of no
significant value
(i.e. no unique
habitats).
Temporary
damage/
disruption (<1
month) to flora or
fauna habitats.
Significant
changes in flora/
fauna populations
and habitat.
Disruption to, or
some death of,
rare flora or fauna,
but not resulting in
eradication of
endangered
species.
Non-persistent but
possibly
widespread
damage to land:
damage that can
be remediated
without long-term
loss; localised
persistent
Continuous and
serious damage
by erosion or to
flora or fauna.
Major disruption
to, or frequent
death of, rare flora
or fauna.
Major destruction
of significant
habitat.
Long-term and
significant change
in population (e.g.
eradication of
endangered
species) or habitat
with negative
impact on
ecosystem
function.
Widespread
destruction to a
significant area of
land, rare flora
and fauna and/or
groundwater
resource.
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APPENDIX 1: EHS INCIDENT SEVERITY ASSESSMENT GUIDELINES
MINOR SERIOUS MAJOR
Area impacted
Insignificant
Consequences
Minor
Consequences
Moderate
Consequences
Major
Consequences
Catastrophic
Consequences
damage; or
significant
temporary
damage (<1 year)
to ecosystem.
Aquatic ecosystem Occasional short-
term impact and/or
disruption to
aquatic flora and
fauna.
Minor impact on
aquatic
ecosystem,
including flora,
fauna and habitat.
No significant
impact on water
resources.
Significant
localised impacts
but without longer-
term impact on
aquatic
ecosystems,
and/or short term
impacts on water
resources.
Significant
widespread impact
on protected
wildlife (e.g.
migratory
shorebirds, marine
plants, fish
breeding grounds),
or aquatic
ecosystems of
moderate
duration.
Damage to an
extensive portion
of aquatic
ecosystem
resulting in severe
impacts on aquatic
populations and
habitats and/or
long-term impact
on water
resources.
Atmosphere/waste/other Temporary
nuisance from
noise, odour, dust,
other air
emissions,
Minor
environmental
impact due to
contained release
of pollutant
Creation of noise,
odour, dust, other
controlled/
uncontrolled air
emissions,
Major
environmental
impact due to
uncontained
release, fire or
Catastrophic
environmental
impact due to
uncontained
release, fire or
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APPENDIX 1: EHS INCIDENT SEVERITY ASSESSMENT GUIDELINES
MINOR SERIOUS MAJOR
Area impacted
Insignificant
Consequences
Minor
Consequences
Moderate
Consequences
Major
Consequences
Catastrophic
Consequences
greenhouse
gases, vibration,
visual impact.
Minor use of
water, fuels and
energy and other
natural resources.
Results in the
generation of
significant
quantities of non-
hazardous wastes.
(including odour,
dust and noise),
fire or explosion
with no lasting
detrimental
effects. No outside
assistance
required.
Significant use of
water, fuels and
energy and other
natural resources.
greenhouse
gases, vibration,
and visual impact
at significant
nuisance levels.
Results in the
generation of
significant
quantities of
hazardous wastes.
explosion with
detrimental
effects. Outside
assistance
required.
explosion with
detrimental effects.
Outside assistance
required.
Extensive chronic
discharge of
persistent
hazardous
pollutant.
Results in the
generation of
significant
quantities of
intractable wastes.
Cultural heritage
(indigenous and modern)
Minor repairable
damage to
commonplace
structures.
Minor repairable
damage to
structures/ items
of cultural
significance, or
minor
infringements of
cultural values.
Moderate damage
to structures/
items of cultural
significance, or
significant
infringement of
cultural values/
sacred locations.
Major damage to
structures/ items
of cultural
significance, or
major infringement
of cultural values/
sacred locations.
Irreparable
damage to highly
valued structures/
items/ locations of
cultural
significance or
sacred value.
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APPENDIX 1: EHS INCIDENT SEVERITY ASSESSMENT GUIDELINES
MINOR SERIOUS MAJOR
Area impacted
Insignificant
Consequences
Minor
Consequences
Moderate
Consequences
Major
Consequences
Catastrophic
Consequences
HEALTH
Health Effects Insignificant
impact on
surrounding
communities.
Minor complaints
or exposure during
plant shutdown or
maintenance.
Maximum
occurrence limited
to two times per
year
Ongoing
complaints from
community.
Significant
emission or
discharge that
impacts on
surrounding
population.
Major ongoing
long-term health
effects likely to
surrounding
communities and
workers.

Extreme health
risk potential for
death in
community.
SAFETY
Human Health and Safety Near miss incident
or trivial injuries,
which may require
self-administered
first aid. Injured
personnel can
continue to
perform normal
duties.
Injuries requiring
on-site treatment
by medical
practitioner.
Personnel unable
to continue to
perform duties.
Serious injuries
requiring off-site
treatment by
medical
practitioner or
immediate
evacuation to
hospital. Potential
long-term or
Single fatality. Multiple fatalities.
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APPENDIX 1: EHS INCIDENT SEVERITY ASSESSMENT GUIDELINES
MINOR SERIOUS MAJOR
Area impacted
Insignificant
Consequences
Minor
Consequences
Moderate
Consequences
Major
Consequences
Catastrophic
Consequences
permanently
disabling effects.
Production Loss Incident event
without causing
production loss.
Production loss or
delay up to one
week.
Production loss or
delay of one week
to one month.
Production loss or
delay for over one
month.
Loss of licence to
operate or ability
to produce
indefinitely.
Total cost of impacts or
incident event
Financial loss
(compensation,
fines, cost to
repair, plant
damage) of less
than AED5,000
Financial loss
(compensation,
fines, cost to
repair, plant
damage) of
AED5,000 -
AED50,000.
Financial loss
(compensation,
fines, cost to
repair, plant
damage) of
AED50,000 -
AED500,000
Financial loss
(compensation,
fines, cost to
repair, plant
damage) of
AED500,000 -
AED10M.
Severe financial
penalties or legal
liabilities. Financial
loss
(compensation,
fines, cost to
repair, plant
damage) of
greater than
AED10M.
Source:
Abu Dhabi Emirate EHS Management System Manual 2007 CoP3 on Risk Management by Environment Agency Abu Dhabi
Adapted from Standards Australia/ Standards New Zealand HB 203:2000, Environmental Risk Management Principles and
Process 2001, Appendix F and 4360: 1999, Risk Management 1999,
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APPENDIX 2: INJURY / ILLNESS CLASSIFICATION GUIDELINES













Event or Exposure
Resulting in Injury
or Illness
Employee Engaged
in Work-Related
Activity
Employee Present
at the Location as a
Condition of
Employment
Employee in Travel
Status and Engaged
in Work or Travel
Function
Employee Engaged
in Personal Activity
or Enjoyment
Presumed
Work-Related
Not work related
NOTE: The word Employee wherever used in these guidelines is synonym to Employee, Staff, Worker. Contractor, Visitor as defined in
this document
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Injury or Illness to a worker
(employee or contract er)
Not Work-related
Results from accident or exposure
not related to work
Disabling
Incident
(lost ti me)
Restricted Work Case
Modified work or
transfer to another job
Lost
Workday
Case
Reportable Injury or Illness
Injury or Illness to a worker
(employee or contractor)
Work-related
Results from accident or exposure
in the work environment and i s:
Work- related
Results from accident or exposure
in the work environment and i s:
Not Work
-
related
Results from accident or exposure
not related to work
Fatality
Disabling
Incident
(lost ti me)
Disabling
Incident
(lost ti me)
Modified work or
transfer to another job
Modified work or
transfer to another job
Medical Treatment
Case
Not First Aid
Not required to report.
Consi der shari ng
learning.
Not required to report.
Consi der shari ng
learning.
Enter into
First Ai d
Log
Enter into
First Ai d
Log
Enter into
First Ai d
Log
First
Aid
First
Aid
First
Aid
Injury or Illness to a worker
(employee or contract er)
Not Work-related
Results from accident or exposure
not related to work
Disabling
Incident
(lost ti me)
Disabling
Incident
(lost ti me)
Restricted Work Case
Modified work or
transfer to another job
Lost
Workday
Case
Reportable Injury or Illness
Injury or Illness to a worker
(employee or contractor)
Work-related
Results from accident or exposure
in the work environment and i s:
Work- related
Results from accident or exposure
in the work environment and i s:
Work-related
Results from accident or exposure
in the work environment and i s:
Work- related
Results from accident or exposure
in the work environment and i s:
Not Work
-
related
Results from accident or exposure
not related to work
Fatality
Disabling
Incident
(lost ti me)
Disabling
Incident
(lost ti me)
Modified work or
transfer to another job
Modified work or
transfer to another job
Medical Treatment
Case
Not First Aid
Not required to report.
Consi der shari ng
learning.
Not required to report.
Consi der shari ng
learning.
Enter into
First Ai d
Log
Enter into
First Ai d
Log
Enter into
First Ai d
Log
Enter into
First Ai d
Log
Enter into
First Ai d
Log
Enter into
First Ai d
Log
Enter into
First Ai d
Log
First
Aid
First
Aid
First
Aid
First
Aid
First
Aid
First
Aid
First
Aid
APPENDIX 2: INJURY / ILLNESS CLASSIFICATION GUIDELINES (contd.)
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APPENDIX 2: INJURY / ILLNESS CLASSIFICATION GUIDELINES (contd.)

MEDICAL TREATMENT CASES

The following are generally considered Medical Treatment Cases:

Treatment of infection.
Application of antiseptics during second or subsequent visit to medical personnel.
Treatment of second or third degree burn(s).
Application of sutures/stitches.
Application of butterfly adhesive dressing(s) or steri strip(s) in lieu of sutures.
Removal of foreign bodies embedded in eye.
Removal of foreign bodies from wound; if procedure is complicated because of
depth of embedment, size or location.
Use of prescription medications (except a single dose administered on first visit
for minor injury or discomfort).
Application of hot or cold compress(es) during second or subsequent visit to
medical personnel.
Cutting away dead skin (surgical debridement).
Application of physiotherapy during second or subsequent visit to medical
personnel.
Visit to a hospital or equivalent medical facility for treatment.
Note: The following procedures by themselves are not considered medical
treatment.
Administration of tetanus shot(s) or booster(s). (However, these shots are often
given in conjunction with more serious injuries; consequently, injuries requiring
these shots may be recordable for other reasons).
Diagnostic procedure, like X-ray or laboratory analysis, unless they lead to further
treatment.
Hospitalization for observation only.
Note: Loss of consciousness. If an employee loses consciousness as the result of
a Work injury, the case must be recorded no matter what type of treatment was
provided. The rationale behind this recording requirement is that loss of
consciousness is generally associated with the more serious injuries.




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APPENDIX 2: INJURY / ILLNESS CLASSIFICATION GUIDELINES (contd.)

BURNS

Reportable medical treatment includes treatment of second- or third-degree burns.
When a blister forms three days after the burn occurs, a first-degree burn (first aid)
must be upgraded to a second-degree burn (medical treatment / reportable). Burns
may result from exposure to heat, chemicals, electricity, intense light and radiation.

a. First Degree Burns:

Only the outer layer of skin is damaged, characterized by reddening of skin, pain and
sometimes swelling. Not reportable if the condition doesn't require repeated
treatment beyond initial antiseptic.

b. Second Degree Burns:

Injure the epidermis and damage the superficial underlying tissues. Characterized
similar to first degree burns but blistering of skin may also occur. Intense pain,
reddening and a mottled skin appearance are common. These cases are reportable
if:
Medical treatment is required beyond initial antiseptic,
Blistering is larger than one inch in diameter, or
Damage is not considered "minor" by a medical professional. An injury is not
"minor" if it:
Must be treated by a physician,
Impairs normal use of limbs or senses,
Results in damage to the physical structure beyond a non-superficial
nature, or
Requires follow-up medical treatment.

c. Third Degree Burns:
Most serious category of burns where the entire skin thickness is affected, with
blackened or blanched (grey-white) skin. Treatment includes de-bridement
(removal of burned skin) and skin grafts. All cases are reportable.

FIRST AID CASES

The following are generally considered First Aid Cases (e.g. one-time treatment and
subsequent observation of minor injuries):

Application of antiseptics during visit to medical personnel.
Treatment of first-degree burn(s).
Application of bandage(s) during first visit to medical personnel.
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Removal of foreign bodies not embedded in eye if only irrigation is required.
Removal of foreign bodies from wound, if procedure is uncomplicated, for
example, by tweezers or other simple technique.
Use of non-prescription medications and administration of single dose of
prescription education on first visit for minor injury or discomfort.
Application of hot or cold compress(es) during first visit to medical personnel.
Application of ointment to abrasions to prevent drying or cracking.
Application of physiotherapy during first visit to medical personnel.
Observation only for injury during visit to medical facility.
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APPENDIX 3
ESTABLISHING WORK-RELATIONSHIP:
1. For any situation where the work relationship is not clearly through these
guidelines, interpretation of ZonesCorp HSE shall be obtained and considered
final
2. Work-relatedness is presumed for injuries and illnesses resulting from events or
exposures occurring in the work environment.
3. A case is presumed work-related if an event or exposure in the work environment
caused or contributed the injury or illness or of a significant aggravation to a pre-
existing condition.
4. A case is not recordable if it involves signs or symptoms that surface at work but
resulted from a non-work-related event or exposure that occurred outside of the
work environment.
5. If it is not obvious whether the event or exposure occurred in the work
environment or elsewhere, the employee's work duties and environment shall be
evaluated to decide whether or not one or more events or exposures in the work
environment caused or contributed to the resulting condition or significantly
aggravated a pre-existing condition. This verification should be made in line with
the accident investigation requirements as outlined in this document
6. The Entitys EHS Department / Staff shall establish that the injury/illness is work /
occupational related.
7. The Injuries classification and establishing the work/occupational relationship
shall be done in accordance with the Injury/Illness Classification Guidelines
(Appendix 2).
8. The aggravation of a previous injury/illness almost always results from some new
incidents. These incidents should be recorded as new cases. However, if the
injury/illness results solely because of a previous physical defect or injury/illness
and is not as a result of any work related activity then it is not recordable.
9. If the aggravation is due to normal routine work it shall be recorded as a new
case. An old injury which has not been properly healed may aggravate due to
work stress (especially physical stress) shall be recorded as new case.
10. If the work environment did contribute to the aggravation (employee slips or falls)
then the aggravation of existing condition should be recorded as a new
recordable case..
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11. EXEMPTIONS:
The following are not considered work related:
a. At the time of the injury or illness, the employee was present in the work
environment as a member of the general public rather than as an
employee.
b. Symptoms arising on premises totally due to outside factors
c. Voluntary participation in a wellness program or in a medical, fitness, or
recreational activity such as blood donation, physical examination, flu shot,
exercise class, sport etc.
d. Eating, drinking and preparing one's own food
e. Personal tasks outside working hours
f. Personal grooming, self-medication, self infliction
g. Personal Motor Vehicle Incidents in parking lot / access road during
commute
h. Cold or flu
12. COMMUTING / PARKING LOTS
a. Injuries incurred during a normal commute to and from work in personal
vehicles are not presumed to be work-related.
b. Injuries incurred while commuting in company serviced vehicles (lorries,
busses, coasters etc.) shall be recordable.
c. Travel after work between a worker's residence and a First Aid training
class which he or she attended as part of employment would be
considered work-related.
d. For workers who travel among several work sites during the day (e.g.,
construction project supervisors who do not always report to a home office
prior to beginning their first assignment at the start of the work shift), their
travel from home to the first work site and from the last work site to home
is considered their normal commute. After completion of the work at the
first assignment, injuries sustained travelling to and from other work sites
are considered work-related.
e. Entity Parking Facilities used for the workers daily commuting are
generally not considered part of the employer's premises. Injuries or
illnesses which occur to workers on these parking lots are not presumed to
be work-related, and are not reportable unless the worker was engaged in
some work-related activity or present as a condition of employment.
f. A parking lot is defined as the area on which cars can be parked; it does
not include surrounding sidewalks, which are considered part of the
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employers premises. Stairs and sidewalks contained within the perimeter
of a parking garage or facility are considered part of the parking lot
g. A parking lot ends with the perimeter of the parking pavement or surface.
The boundary could be the fence surrounding the parking lot in one case,
or the curb encircling the parking spaces in another. Parking ramps are
normally considered part of parking facilities, not part of the employer's
premises.
h. Injuries from a fight between workers in a company parking lot are not
work-related.
i. Injuries incurred in a parking lot while repairing it or while going on a work-
related trip are work-related.
j. Injuries incurred while passing through a parking lot to get from Building A
to Building B on the employers premises are considered work-related,
since the worker had completed the commute to work.
k. Where a worker has to use a swipe badge to get through the company
gate and is then on the employers premises, but has an injury before
reaching the parking lot, the injury is considered to have occurred during a
normal commute and is not presumed to be work-related.
l. Injuries occurring on a public sidewalk while walking from a parking lot to
an employers premises are considered to be part of the normal commute
and not reportable. Injuries incurred on a public sidewalk during a break
are not presumed to be work-related. Injuries incurred on a public
sidewalk while engaged in work-related activity, such as walking to a
business meeting, are reportable.
m. If an injury occurs in a company-maintained parking lot during normal
commuting due to a deficiency in that parking lot (such as potholes,
slippery conditions, accumulated debris, etc.), then the injury is work-
related and reportable.
13. COMPANY RESTROOMS, HALLWAYS, OR CAFETERIAS
a. These facilities are generally all considered to be part of the employers
premises and constitute part of the work environment.
b. Injuries incurred in a cafeteria open to the general public are not presumed
to be work-related, however, even though the cafeteria is in a building
owned by the employer and the employer subsidizes the cost of the
cafeteria. The specific activity the employee was engaged in at the time of
the injury is not the controlling factor.
14. WORKING AT HOME:
a. If a worker was involved in a formal company-sponsored program for
"working at home", injuries or illnesses incurred while performing duties in
the interest of the employer while at home would be work-related.
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b. A person with his or her home as an office is considered at work when he
or she is in that office and when he or she leaves his premises in the
interest of the company.
c. Similarly, if a worker was injured on the job and was assigned to work at
home as a result of the injury, injuries or illnesses incurred while
performing duties in the interest of the employer while at home would be
work-related.
d. If a worker who works from his or her home becomes injured or ill while
performing normal life activities (e.g., eating), the case would not be work-
related. When a worker who works at home develops carpal tunnel
syndrome, it must be determined whether the worker's work duties in any
way caused, contributed to, or aggravated his or her condition. If so, it is
considered work-related.
e. If the worker was injured at home while performing duties in the interest of
the employer, the injury would be work-related; pay status is not a factor.
f. Company rented accommodation and/or workers residential cities, labour
camps etc. shall not be treated as Work Environment unless classified in
line with requirements of this Section.
15. TRAVEL
a. Workers who travel on company business are considered to be engaged
in work-related activities all the time they spend in the interest of the
company, including, but not limited to, travel to and from customer
contacts; and entertaining or being entertained for the purpose of
transacting, discussing, or promoting business, etc. However, an injury or
illness would not be reportable if it occurred during normal life activities
(eating, sleeping, recreation); or if the worker deviates from a reasonably
direct route (side trip for vacation or other personal reasons). He or she
would again be in the course of employment when he or she returned to
the normal route of travel.
b. Any travel between a worker's residence and a point outside of the
worker's normal area of operations is not considered a normal commute
and is considered work-related. A worker's "normal geographic area of
operation" includes the town or city where the worker normally works and
directly adjoining municipalities.
c. Where a worker is injured in the parking lot of an off-site facility, whether
the injury is considered work-related or not depends on whether the
worker was in travel status or engaged in a normal commute. If the worker
was in travel status, the injury is considered work-related.
d. An injury on the way to the airport for a business trip is considered being in
travel status. When in travel status, work-related activities begin when the
worker leaves home, assuming that the worker did not intend to report to
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the office before beginning the trip. This is true even if the worker travelled
on a weekend to save the cost of the plane ticket; the timing of the trip is
not a factor to be considered since the worker was travelling for business
purposes.
e. When a worker on travel status is injured while participating in recreational
activities with a customer, whether the injury is work-related depends on
whether the worker's participation in the activities was work-related.
Thus, an off-road accident over the weekend would not be work-related if
solely for recreational purposes, but would be work-related if the off-road
included transacting, promoting, or discussing business, or was perceived
by the worker to be an expectation of employment.
f. Bleeding from the ear due to a pressure change while on a work-related
airplane flight would be a work-related illness (classified as "illness"
because the change in air pressure causing the damage was not
instantaneous).
g. A mugging (assault/attack) while in travel status could result in a work-
related injury.
h. When a travelling worker checks into a hotel or motel, he or she
establishes a "home away from home". Thereafter, his or her activities are
evaluated in the same manner as for non-travelling workers. For example
if a worker on travel status is to report each day to a fixed worksite, then
injuries sustained when travelling to this worksite would be considered
work related. The rationale is that since a worker's normal commute from
home to office would be considered work-related, an injury that occurs
during work away from home would also be considered work related.
i. There are situations where workers in travel status report to, or rotate
among, several different worksites after they establish their "home away
from home" (such as a salesperson travelling to and from different
customer contacts). In these situations, the injuries sustained when
travelling to and from the sales locations would be considered work-
related.
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16. MOTOR VEHICLE INCIDENT (MVI)
a. Company and Contractor Motor Vehicle Incidents shall be reported
separately for each of the 3 categories of Major, Serious & Minor.
b. The below mentioned MVI severity determination criteria shall be
considered in conjunction with Incident Severity Guidelines Appendix 2
Major
Any rollover
Any Entity or Contractor Fatality(s) associated with a MVC
Serious
Any rollover
Any MVI where the Entity or Contractor has a Lost Work Day
Case (s) associated with the MVI
Minor
Any MVI where the Entity or Contractor has a injury (Medical
Treatment or First Aid Case (s)) associated with the MVI
Any MVI where the vehicle cannot be driven from the scene
under its own power in a roadworthy state.
16.1 Vehicles covered
All light duty, heavy duty and plant including buses or coaches (see definitions
for additional clarification).
16.2 Definitions
a. Motor Vehicle:
Any mechanically or electrically powered device (excluding one moved
by human power), upon which or by which any person or property may
be transported upon a land roadway. This includes motorcycles.
Specifically excluded from the definition of motor vehicle are vehicles
operated on fixed rails. In addition, vehicles which are not capable of
more than 10 mph (16 kph) may be exempted.
b. Motor Vehicle Incident: Work Related Vehicle Damage or Personal injury
due to a vehicle related event, or rollover.
The following should not be reported as motor vehicle incidents when the
vehicle is properly parked:
injuries that occur when entering or exiting the vehicle;
Any event involving loading or unloading from the vehicle;
Damage to or total loss of a vehicle solely due to environmental
conditions or vandalism;
In addition the following should not be reported as a motor vehicle
incident:
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Superficial damage, such as a stone or rock chip damaging a
windscreen or paintwork while the vehicle is being driven;
Damage related to the theft of a vehicle.
c. Rollover: Any incident where the vehicle has flipped to its sides, top
and/or rolled 360 degrees via any axis.
d. Work Relationship:
Any incident involving a company, rental or personal vehicle while
performing company business.
Work relationship is presumed for incidents resulting from business
being conducted on behalf of the company while operating a company
assigned vehicle. Examples of company business include driving a
client to the airport, driving to the airport for a business trip, taking a
client or work colleague out for an official meal, deliveries, visiting
clients or customers, or driving to a business related appointment.
Personal business which should not be counted includes, but is not
limited to, running an errand, getting a meal by yourself, commuting to
and from home, or driving to a medical appointment.
Contractor Motor Vehicle Incident includes any vehicle procured
(owned, leased, fleeted or rented) by a contractor or sub-contractor
while performing work on behalf of the company.
For details refer to preceding sub-sections



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APPENDIX 4
LOSS CAUSATION MODEL
A.1 Introduction
The loss causation model shown in Figure A1 contains the necessary key
points that enable the user to understand and retain the critical few facts
important to control of the vast majority of incidents, losses and management
problems.
From left to right, the Loss Causation Model describes a cause-and-effect
relationship that ultimately results in accidental loss. Read from right to left,
however, this same model becomes a powerful problem-solving tool.
Figure A1: Loss Causation Model


A.2 Loss: Unintended Harm or Damage
The result of an incident (except a near-miss) is loss. The most obvious
losses are harm to people, and property damage. Implied and important
related losses are performance interruption and profit reduction. Losses,
therefore involve harm or damage to anything in the occupational or external
environment. Because of its ease of recognition, much of our discussion will
relate to on-the-job injury, illness and property damage.
Once the sequence has occurred, the type and degree of loss are somewhat
a matter of chance. The effect may range from insignificant to catastrophic,
from a scratch or dent to multiple fatalities or loss of a plant.
The type and degree of loss depend partly on fortuitous circumstances and
partly on the actions taken to minimise loss. Actions to minimise loss at this
stage of the sequence may include:
a. Prompt and proper first aid and medical care;
b. Fast and effective fire fighting;
c. Prompt repair of damaged equipment and facilities;
d. Efficient implementation of emergency action plans, and
e. Effective rehabilitation of people for work.
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A.3 Incident: An Event
This is the event that precedes the loss, i.e. the contact that could or does
cause the harm or damage to anything in the working or external
environment. When potential causes of accidents are permitted to exist, the
way is always open for a contact with a source of energy or substance above
the threshold limit of the body or structure. As an example, a flying or moving
object involves kinetic energy which transfers to the body or structure it hits or
contacts. If the amount of energy transferred is beyond the threshold limit, it
causes personal harm or property damage. This is true not only of kinetic
energy but also electrical, acoustic, thermal, radiant and chemical energy.
Here are some of the more common types of energy transfers and substance
contacts:
a. Struck against (running or bumping into)
b. Struck by (hit by moving object)
c. Fall to lower level (either the body falls or the object falls and hits the body)
d. Fall on same level (slip and fall, tip over)
e. Caught in (pinch and nip points)
f. Caught on (snagged, hung)
g. Caught between (crushed or amputated)
h. Contact with (any harmful energy or substance; includes ignition,
explosions, emissions, etc.)
i. Overstress/overexertion/overload.
A.4 Immediate Causes: Substandard Acts/Practices and Conditions
The immediate causes of incidents are the circumstances that immediately
precede the contact. They usually can be seen or sensed. Frequently they are
called unsafe acts or practices (behaviours which could permit the occurrence
of an accident) and unsafe conditions (circumstances which could permit the
occurrence of an accident).
Loss control managers tend to think in terms of substandard practices and
substandard conditions (deviations from an accepted standard or practice).
This line of thinking has distinct advantages:
a. It relates practices and conditions to a performance standard a basis for
measurement, evaluation and correction.
b. It somewhat minimises the blame-fixing stigma of the term unsafe act.
c. It broadens the scope of interest from accident control to loss control,
encompassing safety, quality, production, and cost control.
d. Some people advocate substituting the word error (e.g., management
error, operational error, maintenance error, engineering error) to identify
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management responsibility. The term error, however, is often
misunderstood as blame.
e. Blame leads to defensive behaviour and safety problems get disguised
rather than solved. Also, an increasing number of safety leaders confirm
the results from research in quality control that as many as 85% of the
mistakes (substandard/unsafe acts) that people make are the result of
factors over which only management has control. This significant finding
gives a completely new direction of control to the long-held perception that
85-96% of accidents result from the unsafe acts or faults of people.
This new direction of thinking encourages the progressive manager to
think in terms of how the management system influences human
behaviour rather than just on the unsafe acts of people. Thus, the term
substandard seems more acceptable, more useful, more professional, and
more in tune with the times.
Substandard practices and conditions may be seen in one or more of the
forms indicated in Table A1 and Table A2.
Table A1: SUBSTANDARD PRACTICES
Operating equipment without authority
Failure to warn
Failure to secure
Operating at improper speed
Making safety devices inoperable
Removing safety devices
Using defective equipment
Using equipment improperly
Failing to use personal protective
equipment properly
Improper loading
Improper placement
Improper lifting
Improper position for task
Servicing equipment in operation
Horseplay
Under influence of alcohol and/or drugs
Failure to follow procedures

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Table A2: SUBSTANDARD CONDITIONS
Inadequate guards or barriers
Inadequate or improper protective
equipment
Defective tools, equipment or materials
Congestion or restricted action
Inadequate warning systems
Fire and explosion hazards
Poor housekeeping or disorderly
workplace
Hazardous environmental conditions;
gases, dusts, smoke, fumes, vapours
Noise exposures
Radiation exposures
High or low temperature exposures
Inadequate or excessive illumination
Inadequate ventilation
It is essential to consider these practices and conditions only as immediate
causes or symptoms, and to do a thorough job of diagnosing the basic causes
behind the symptoms. If only the symptoms are treated, they will occur again
and again. You need to ask the essential question, Why?:
a. Why did that substandard practice occur?
b. Why did that substandard condition exist?
c. Why did our loss control system permit that practice or condition?
d. If the investigation is thorough, the answers will point the way to more
effective control. To solve loss control performance problems, the basic (or
fundamental) causes must be understood and addressed.
A.5 Basic Causes: Personal and Job/System Factors
Basic causes are the diseases or real causes behind the symptoms; the
reasons why the substandard acts and conditions occurred; the factors that,
when identified, permit meaningful management control. Often, these are
referred to as root causes, real causes or underlying causes. While immediate
causes (the symptoms; the substandard acts and conditions) are usually quite
apparent, it takes a bit of probing to get at basic causes and to gain control of
them.
Basic causes help explain why people perform substandard practices.
Logically, a person is not likely to follow an unknown procedure. Likewise, the
operator of complex equipment will not operate it efficiently and safely without
the chance to develop skill through guided practice. It is equally logical that
poor quality of work and substantial waste will result from placing a person
with faulty eyesight on a job where good vision is critical for proper
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performance. Similarly, a person who is never told the importance of a job is
unlikely to be motivated to a high degree of pride in his or her work.
Basic causes also help explain why substandard conditions exist. Equipment
and materials which are inadequate or hazardous will be purchased if there
are not adequate standards, and if compliance with standards is not
managed.
Unsafe structures and work process layouts will be designed and built if there
are not adequate standards and compliance for design and construction.
Equipment will wear out and produce a substandard product, create waste or
break down and cause accidents if that equipment is not properly selected,
properly used and properly maintained.
Just as it is helpful to consider two major categories of immediate causes
(substandard practices and substandard conditions), so is it helpful to think of
basic causes in two major categories: Personal Factors and Job Factors (see
Tables A3 and A4).
Basic causes are the origins of substandard practices and conditions.
However, they are not the beginning of the cause and effect sequence. What
starts the sequence, ending in loss, is lack of control.
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Table A3 - PERSONAL FACTORS
1. Inadequate Physical/Physiological Capability
a) Inappropriate height, weight, size,
strength, reach, etc.
b) Restricted range of body movement
c) Limited ability to sustain body positions
d) Substance sensitivities or allergies
e) Sensitivities to sensory extremes
(temperature, sound, etc.)
f) Vision deficiency
g) Hearing deficiency
h) Other sensory deficiency (touch, taste,
smell, balance)
i) Respiratory incapacity
j) Other permanent physical disabilities
k) Temporary disabilities
2. Inadequate Mental/Psychological Capability
a) Fears and phobias
b) Emotional disturbance
c) Mental illness
d) Intelligence level
e) Inability to comprehend
f) Poor judgment
g) Poor coordination
h) Slow reaction time
i) Low mechanical aptitude
j) Low learning aptitude
k) Memory failure
3. Physical or Physiological Stress
a) Injury or illness
b) Fatigue due to task load or duration
c) Fatigue due to lack of rest
d) Fatigue due to sensory overload
e) Exposure to health hazards
f) Exposure to temperature extremes
g) Oxygen deficiency
h) Atmospheric pressure variation
i) Constrained movement
j) Blood sugar insufficiency
k) Drugs
4. Mental or Psychological Stress
a) Emotional overload
b) Fatigue due to mental task load or speed
c) Extreme judgment/decision demanded
d) Routine, monotony, demand for uneventful
vigilance
e) Extreme concentration/perception
demands
f) Meaningless or degrading activities
g) Confusing directions
h) Conflicting demands
i) Preoccupation with problems
j) Frustration
k) Mental illness
5. Lack of Knowledge
a) Lack of experience
b) Inadequate orientation
c) Inadequate initial training
d) Inadequate update training
e) Misunderstood directions
6. Lack of Skill
a) Inadequate initial instruction
b) Inadequate practice
c) infrequent performance
d) Lack of coaching
7. Improper Motivation
a) Improper performance is rewarding
b) Proper performance is punishing
c) Lack of incentives
d) Excessive frustration
e) Inappropriate aggression
f) Improper attempt to save time or effort
g) Improper attempt to avoid discomfort
h) Improper attempt to gain attention
i) Inappropriate peer pressure
j) Improper supervisory example
k) Inadequate performance feedback
l) Inadequate reinforcement of proper
behaviour
m) Inadequate production incentives

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Table A4: JOB FACTORS
1. Inadequate Leadership and/or Supervision
a) Unclear or conflicting reporting relationships
b) Unclear or conflicting assignment of
responsibility
c) Improper or insufficient delegation
d) Giving inadequate policy, procedure, practices
or guidelines
e) Giving conflicting objectives, goals or
standards
f) Inadequate work planning or programming
g) Inadequate instructions, orientation and/or
training
h) Providing inadequate reference documents,
directives and Guidance publications
i) Inadequate identification and evaluation of loss
exposures
j) Lack of supervisory/management job
knowledge
k) Inadequate matching of individual
qualifications and job/task requirements
l) Inadequate performance measurements and
evaluation
m) Inadequate or incorrect performance
feedback
2. Inadequate Engineering
a) Inadequate assessment of loss exposures
b) Inadequate consideration of human
factors/ergonomics
c) Inadequate standards, specifications and/or
design criteria
d) Inadequate monitoring of construction
e) Inadequate assessment of operational
readiness
f) Inadequate monitoring of initial operation
g) Inadequate evaluation of changes
3. Inadequate Purchasing
a) Inadequate specifications on requisitions
b) Inadequate research on
materials/equipment
c) Inadequate specifications to vendors
d) Inadequate mode or route of shipment
e) Inadequate receiving inspection and
acceptance
f) Inadequate communication of safety and
health data
g) Improper handling of materials
h) Improper storage of materials
i) Improper transporting of materials
j) Inadequate identification of hazardous items
k) Improper salvage and/or waste disposal

4. Inadequate Maintenance
a) Inadequate preventive
Assessment of needs
Lubrication and servicing
Adjustment/assembly
Cleaning or resurfacing
b) Inadequate reparative
...Communication of needs
...Scheduling of work
...Examination of units
...Part substitution
5. Inadequate Tools and Equipment
a) Inadequate assessment of needs and risks
b) Inadequate human factors/ergonomics
considerations
c) Inadequate standards or specifications
d) Inadequate availability
e) Inadequate adjustment/repair/maintenance
f) Inadequate salvage and reclamation
g) Inadequate removal and replacement of
unsuitable items
6. Inadequate Work Standards
a) Inadequate development of standards
...Inventory and evaluation of exposures &
needs
...Coordination with process design
...Employee involvement
...Inconsistent standards/procedures/rules
b) Inadequate communication of standards
...Publication
...Distribution
...Translation to appropriate languages
...reinforcing with signs, color codes & job
aids
c) Inadequate maintenance of standards
...Tracking of work flow
...Updating
...Monitoring use of standards / procedures
/ rules
7. Wear and Tear
a) Inadequate planning of use
b) Improper extension of service life
c) Inadequate inspection and/or monitoring
d) Improper loading or rate of use
e) Inadequate maintenance
f) Use by unqualified or untrained people
g) Use for wrong purpose
8. Abuse or Misuse
a) Condoned by supervision
...Intentional /...Unintentional
b) Not condoned by supervision
...Intentional / ...Unintentional
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A.6 Lack of Control: Inadequate System, Standards and/or Compliance
Control is one of the four essential management functions: plan, organise,
lead/direct, control. These functions relate to any manager's work, regardless
of level, title or managed activity.
The person who manages professionally knows the loss control programme;
knows the performance standards; plans and organises work to meet the
standards; leads people to attain the standards; measures performance of self
and others; evaluates results and needs; commends and constructively
corrects performance. This is management control. Without it, the sequence
of events begins and triggers the continuing causal factors that lead to loss.
Without adequate management control, the accident cause and effect
sequence is started and, unless corrected in time, leads to losses.
There are three common reasons for lack of control:
a. Inadequate system
b. Inadequate standards, and
c. Inadequate compliance with standards.
Inadequate System
A safety/loss control system may be inadequate because of too few or improper
system activities. While the necessary activities vary with an organisation's scope,
nature, type, and risk potential, significant research and the experience of successful
programmes in many different companies and countries show that there are
common elements for building an adequate safety/loss control management system.
Inadequate Performance Standards
A common cause of confusion and failure is standards that are not specific enough,
not clear enough and/or not high enough. Standards let people know what is
expected of them and permit meaningful measurement of how well they perform in
relation to the standards. Simply put, standards specify who does what and when or
how often. Adequate standards are essential for adequate control.
Inadequate Compliance with Standards
Lack of compliance with existing standards is a common reason for lack of control. In
fact, many managers feel that this is the single greatest reason for failure to control
accident loss (although studies have shown that failure is more often associated with
inadequate standards, not compliance).
Correcting these three common reasons for lack of control is a critical
management/leadership responsibility. Developing an adequate system and
standards is an executive function, aided by supervisors. Maintaining compliance
with standards is a supervisory/team leader function, aided by executives. Figure A2
shows the causation model with details for each step in the sequence.
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Figure A2: Loss Causation Model (Detailed)


.
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A.7 Incident Causation
Incident investigation, as with any other aspect of the loss control process,
should be guided by clear activities and standards which actively encourage
compliance. People should fully understand what types of situations are to be
investigated, by whom and what timeframe is acceptable. Those who may
investigate should be trained in suitable techniques. As with many
management control activities, effectiveness requires training. In simple
terms, effective investigations dont just happen they are the results of a well-
managed investigation process.
All incidents should be evaluated for risk potential. Those incidents having HI-
PO (high potential for loss) should be investigated fully regardless of the
severity of the actual loss which has occurred.
Near-miss investigation is an extremely important part of this process:
a. There are many more incidents than accidents;
b. Lessons learned from near-misses are free;
c. The causes and potential are exactly the same.
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APPENDIX 5
ZonesCorp HEALTH SAFETY & ENVIRONMENT CONTACT LIST
AS OF SEPTEMBER, 2008*


Title Tel.
Fax E-mail
HSE Manager 02-5073372 02-5073564 hse@zonescorp.com
Health & Environment
Specialist
02-5073308 02-5073564 hse@zonescorp.com
Safety & Risk Specialist 02-5073418 02-5073564 hse@zonescorp.com
Emergency Preparedness
& Fire Engineer
02-5073427 02-5073564 hse@zonescorp.com
Database Administrator 02-5073358 02-5073564 hse@zonescorp.com

Note: The Contact List shall be updated and communicated to all concerned as and
when required.
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Form No.: ZC-COPEHS05-F001
EHS Incident Notification Form
INCIDENT NO.: _________________ DATE OF REPORTING: _______________________
1. Name of the Entity: _________________________ Location: ____________________
2. Date of the Incident (DD/MM/YY):____/___ /____ Time of the Incident: _____:_____ AM/PM
3. Type of Incident: Safety Health Environment
4. Severity of Incident: Major Serious Minor
(Refer to EHS Incident Severity Determination Guidelines - Appendix 1)
5. Classification of Incident:
Injury Illness Fire Explosion Property Damage Near-miss Spill to Soil
Off Specs Air Emissions Off Specs Waste Water Discharge Spill to Groundwater
Spill to Free Flowing Channels (Sea, Storm Water) Noise Damage to Flora/Fauna
Chemical/Oil Spill or Release Uncontrolled Radioactivity Release Vehicles Others
7. Duration of Spill/ Release: _________ Minutes / Hours
8. Name of Chemical(s) Spilled / Released: _______________________________
9. Approx Quantity of Spill / Release: _________ Metric Tons
10. Wind Direction: ___________ 11. Wind Condition: Stable Windy
12. Classification & Number of Injury/ Illness:
Fatality Lost Workday Restricted Workday Medical Treatment First Aid
(Put number of injuries/illnesses for each category. Refer to Injury/Illness Classification
Guidelines Appendix 2 and Establishing Work Relationship Guidelines Appendix 3)
13. Status of Industrial Unit: In Operation Shutdown
Shutdown because of the Incident: Yes No
14. Description of Incident:



15. Immediate Action(s) Taken:



Is Detailed Investigation Required? Yes No
NAME POSITION SIGNATURE / DATE
Prepared by:
Approved by:

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Form No.: ZC-COPEHS05-F002
Incident No: ______________

EHS INCIDENT INVESTIGATION LEADERS PREPARATION CHECK LIST
(To be filled by the Team Leader immediately on appointment)

YES NO
1. Does the Team include representative of department where
the incident occurred, and other personnel with specific skills
required for this investigation?

2. Is ZonesCorp EHS representative part of the investigation team

3. Were the contractor employee(s) involved in the incident?

If Yes, is a Contractor representative included in the investigation Team?

4. Is Team charter defined?

5. Is the preliminary completion date for the investigation defined?

6. Has the incident been classified?

7. Has written statements been obtained from the concerned area personnel
(including emergency response team)?

8. Has the area been barricaded with clear instruction that material shall not
be removed unless authorized by the investigation Team Leader?

9. Have copies of process parameters, control and alarm data and chart
copies been obtained?

10. Have copies of log reports / log sheets been obtained?

11. Have photographs of accident location/equipment involved in the accident
been taken ?

12. Have you visited the area with the team to visually inspect
the site of the incident?

13. Have you received formal training on investigation procedures
& techniques?


Name: _____________________________ Signature/Date________________________


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Form No. ZC-COPEHS05-F003
Incident No: ____________
EHS INCIDENT WITNESS STATEMENT

Name:


Employee No.:
Job Title: Supervisors Name:



Incident Date:

Incident Time:


1. Where were you at the time of the incident?



2. What were the working conditions (workplace and weather?)



Write down what happened, beginning with the normal job activity that led to the
incident. Put the events, as far as possible, in the order they happened. Try to indicate
timing. Say where other people were and what they did. Describe emergency response
activities.






Please explain and list down the things/items that were moved or repositioned after the
incident?



Who else might have useful information on the incident?



Signature/ Date:



Work Telephone

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Form No.: ZC-COPEHS05-F004
EHS INCIDENT INTERVIEW NOTES / CHECKLIST
Incident Description: Incident Date / Time: Reference #


Interview date:


Interview Time:

Time ended:
Name / Tel. #


Job Title: Supervisors Name / Tel. #
1. What were you doing before the incident happened?



2. Where were you at the time of the incident?



3. What were the working conditions like (workplace and weather?)



Please tell me about what happened (what you saw and did, who else was involved,
approximate times, how long things went on for)


4. Types of equipment involved?


5. Locations of: anyone involved, hurt, equipment, materials?


6. Positions of: anyone involved, anyone hurt, equipment, materials?


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EHS INCIDENT INTERVIEW NOTES / CHECKLIST
7. Operating conditions before and after?


8. What other people were doing?


9. Names of people involved / hurt?


10. Emergency response actions?


11. Anything moved, repositioned? (to control situation / emergency response)


12. Job preparation / training?


13. Who else might have valuable information?


14. Any similar incidents before?


15. Is there anything else you would like to mention, no matter how unimportant it seems?


16. Do you have suggestions for possible improvements?


Please contact me if you think of anything else that might be important.
Interviewee:

____________ ___________ _______
Name Signature Date
Interviewer:

_____________ ___________ ________
Name Signature Date

Follow up notes:



CODE OF PRACTICE
EHS INCIDENT REPORTING & INVESTIGATION



Document No ZC-COP-EHS05 Rev. No. 0 Date of Issue 21 Sept. 2008
ZonesCorp Environment Health & Safety Code Page 64 of 67

Form No. ZC-COPEHS05-F005
Incident No: _________________
To: The Appointing Authority
EHS INCIDENT PRELIMINARY INVESTIGATION REPORT

Incident Summary
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________


Brief Process of investigation
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________


Data gathered
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________


Actions to be taken before resuming normal activities
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________



NAME SIGNATURE & DATE
(Team Leader)

CODE OF PRACTICE
EHS INCIDENT REPORTING & INVESTIGATION



Document No ZC-COP-EHS05 Rev. No. 0 Date of Issue 21 Sept. 2008
ZonesCorp Environment Health & Safety Code Page 65 of 67

Form No. ZC-COPEHS05-F006
Incident No: __________
T GATION SUMMARY REPOR EHS INCIDENT INVESTI


1. Name of the Entity:__________________________________________________

2. Location: :____________________________________________________

3. Date of the incident (DD/MM/YY): __/__/_____Date investigation started: __/__/____


4. Time of the incident: _____:______


5. Description of Incident:
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________

6. Root cause(s) of the incident:

___________________________________________________________________


7. Key recommendations to prevent recurrence of such incidents:

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________



NAME POSITION SIGNATURE / DATE

Date and Time of issuance:

CODE OF PRACTICE
EHS INCIDENT REPORTING & INVESTIGATION



Document No ZC-COP-EHS05 Rev. No. 0 Date of Issue 21 Sept. 2008
ZonesCorp Environment Health & Safety Code Page 66 of 67

Form No. ZC-COPEHS05-F007
Incident No.: _________
EHS INCIDENT ANALYSIS

Entity Name / Location: __________________________
The person(s) who was involved in the incident:
Entity Employee [ ] / Contractor Employee [ ]
If Contractor Employee was involved:
Name of Contractor: __________________
Is the Contractor Injury/ Illness recordable: Yes/ No
Direct Cause(s) of the Incident
[ ] Equipment Failure [ ] Personnel Error
[ ] Other (natural phenomena, external event, sabotage etc________________
Root Cause(s) (Fill-in how many of each category):
[ ] Design Input/Output [ ] Procedure
[ ] Equipment Record [ ] Human & Job Factors
[ ] Asset Integrity Program Structure [ ] Training
[ ] Asset Integrity Program Implementation [ ] Immediate Supervision
[ ] Personnel Performance [ ] Administrative Management System
[ ] Communications [ ] Other
Entity Procedure / Standard / Law / ZonesCorp COP Violated:
[ ] Procedure No.. [ ] EHS Standard No[ ] ZonesCorp COP No
[ ] Law / Regulation [ ] Other..
Body Part Injured (if applicable):
[ ] Head [ ] Chest [R/L] Arm [R/L] Leg [ ] Back [ ] Abdomen
[R/L] Hand [ ] Face [R/L] Eyes [R/L] Foot
Cost of the Incident:
Equipment / Property Damaged: DHS. ______________________
Production Loss: DHS. ______________________
Treatment Cost: DHS. ______________________
Absenteeism Cost DHS. ______________________
Other Cost: DHS. ______________________
Total Cost: DHS. ______________________

NAME POSITION SIGNATURE / DATE
CODE OF PRACTICE
EHS INCIDENT REPORTING & INVESTIGATION



Document No ZC-COP-EHS05 Rev. No. 0 Date of Issue 21 Sept. 2008
ZonesCorp Environment Health & Safety Code Page 67 of 67






Note:
For Reporting Purpose
Electronic Copy of EHS
Incident Statistics Report
Form (ZC-COPEHS05-F008)
shall be obtained from
ZonesCorp HSE Dept.

Reporting Entity: Location: Month / Year:
Year-To-Date Total
Major Serious Minor Major Serious Minor
Major Serious Minor
Fatilities LWDC RWDC MTC TOTAL LWDC RWDC MTC TOTAL LWDC RWDC LTIFR LTISR
Manhours Since the Last Lost Workday Injury (Employees) Days Worked Since the Last Lost Workday Injury (Employees):.
Fatilities LWDC RWDC MTC TOTAL LWDC RWDC MTC TOTAL LWDC RWDC LTIFR LTISR
Manhours Since the Last Lost Workday Injury (Contractors):.. Days Worked Since the Last Lost Workday Injury (Contractor):
LEGEND: LWDC - Lost Workdays Case / LTI - Fatality + LWDC / RWDC - Restricted Workdays Case / MTC - Medical Treatment Case / LTIFR - LTI Frequency Rate {(Total No. of LTIs x
1,000,000) / Manhours Worked} / LTISR - LTI Severity Rate {(Lost Work Days x 1,000,000) / Manhours Worked} / TRIR - Total Reportable EHS Incidents Rate: (Total No. of Recordable Injuries x
1,000,000) / Manhours Worked
Number of Recordable Injuries
Number of Recordable Injuries
Health
Environment
Number of Recordable Illness Incidents
Fire / Explosion
Property Damage
Others
Monthly Total
Year-To-Date Total
Off Specs Air Emissions
Number of Environment incidents
Number of Recordable Injury Incidents
Number of Safety Incidents
Summary
Major Serious Minor
Off Specs Waste Water Discharge
Spills to Soil
Spill to Free Flowing Channel (Sea, Storm Water etc.)
Uncontrolled Radioactivity Release
Spills to Ground Water
LTI Rates
Month
LTI Rates
Chemical/Oil Spill not causing Envir. Impacts
Monthly Total
Year-To-Date Total
Damage to Flora & Fauna (animals, insects, plants etc.)
Noise
Others
Year-To-Date
TRIR
Year-To-Date
Manhours
Worked
Month
Number of Recordable Illness
EHS INCIDENT STATISTICS REPORT (ZC-COPEHS05-F008)
Injury / Illness Statistics - Employees
Injury / Illness Statistics - Contractors
Manhours
Worked
Number of Recordable Illness No.of Days Lost
TRIR
Safety
No.of Days Lost
Monthly Total
Year-To-Date Total
Number of Health Incidents