QHSE MANUAL

Document Control No.

PEI-QHSE-003

ACCIDENT AND INCIDENT

REPORTING

Revision : 2
Date Issued: March 2015

HEALTH, SAFETY & ENVIRONMENTAL PROCEDURES

ACCIDENT AND INCIDENT

REPORTING
PEI-QHSE-003

REVISIONS:
DATE

REV.

DESCRIPTION

5 Dec 08

First issue

7 Feb 12

All procedure revised

March 2015

All Procedures Revised

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By

Signature

QHSE MANUAL

ACCIDENT AND INCIDENT

REPORTING

Document Control No.

PEI-QHSE-003
Revision : 2
Date Issued: March 2015

TABLE OF CONTENT

1.0

SCOPE

2.0

DEFENITIONS

3.0

RESPONSIBILITIES

4.0

PROCEDURES

5.0

INCIDENT CLASSIFICATION

ATTACHEMENTS:

1.0

ALLOCATION OF INCIDENT SEVERITY

ACCIDENT AND INCDENT REPORTING FORM

SCOPE

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1.1

Document Control No.

PEI-QHSE-003
Revision : 2
Date Issued: March 2015

This procedure provides the methods, techniques, quality, and reporting systems
required for the reporting of incidents, including allocation of incident severity and
classification, as follows:
a) All work related or non-work related reportable incidents, which occurred while
work is being carried out by the Company.
b) Not covered are theft or integrity failures which are not normally reported as an
HSE incident unless a hazard, near miss or actual injury or damage has occurred
as a result.

1.2

2.0

This procedure shall be adhered to at all times unless Contract or Client requirement
dictate different procedures.

DEFENITIONS
Accident

Any unplanned event, or chain of events, which result in actual

injury, illness, death, damage or loss. All accidents are
incidents but not all incidents are accidents.

Incident

Any unplanned event, or chain of events, which has, or could

have, caused injury, illness, damage or loss. This term shall be
used to include all accidents and near misses.

Incident Reporter

The person or authority responsible for preparing the report

and reporting the incident.

Work Related Incident

An incident that has occurred during the course of employment

and in carrying out work or duties for or on behalf of the
Company.

Non-Work Related Incident

An incident or accident which is not work related and did not

occurred during employment.

Reportable Incident

Any unsafe act and/or conditions or any unplanned events

which involve actual or potential damage to people, assets or
the environment while work is being carried by, for or on behalf
of the Company.

Severity

A measure of the seriousness of the incident on a scale of 1 to

5, the scale is applied in respect to unsafe acts and conditions,
near misses, injury to people and loss or damage to assets or
the environment.

Potential Severity

A measure of how serious the incident could have been given a

different set of circumstances

Actual Severity

A measure of the actual outcome of an incident

Technical Integrity Failure

Describes the controls, procedures and systems in place within

an organization or operating unit that are designed to enable
the organization or operation to function properly and safely
within the designated intent.

Asbestosis

Disease of the lungs caused by long term exposure to asbestos

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3.0

Document Control No.

PEI-QHSE-003
Revision : 2
Date Issued: March 2015

Ergonomics

Science of the relationship between man and his working

environment focused on changing the environment to improve
productivity and minimize injuries and occupational illnesses.

Lost Work Days

Number of calendar days that an injured person was temporary

unable to work as a result of the injury.

Restricted Work Days

Number of calendar days a person able to work but is not able

to carry out his normal duties as the result of an injury.

RESPONSIBILITIES
3.1

Operations / Project Manager (OM)

The OM / PM shall be responsible to ensure that the required resources are made
available to enable proper implementation of this procedure.

3.2

Line Management (LM)

3.2.1
3.2.2

3.3

LM shall be responsible for ensuring that the requirements of this procedure

are fully implemented at all times.
LM shall be responsible for compilation of the incident investigation reports.

Employees
All employees involved in the implementation of this procedure shall be responsible
for adherence to the requirements stated herein.

3.4

4.0

Safety Officer (CSM)

3.4.1

The CSO shall retain the original of all reports and maintain files as specified
in the File Management System.

3.4.2

The CSP shall be responsible that the report is copied and distributed to all
relevant departments and persons.

PROCEDURES
4.1

Any employee witnessing an incident or accident shall immediately notify his/her LM.

4.2

The LM shall immediately investigate the incident and shall submit to the CSO full
details of the incident. Formal written report shall be submitted to the CSO not later
than 48 hours after the incident.

4.3

The OM shall notify the Client Representative as soon as possible after receiving
report of an incident or accident.

4.4

After receipt of the Incident Report, the CSO shall determine if further investigation
and/or action is required. If warranted, an internal audit shall be carried out at the first
available opportunity, if possible within seven (7) days, to determine if further action is
required such as change in operation procedures, Corrective Action, etc. and report
such findings to the OM.
The Internal Audit/Investigation Team shall consist of:

4.5

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OM
CR
CSO
FS
Other

o
o
o
o
o
Leve
l
1
2
3
4

5.0

PEI-QHSE-003
Revision : 2
Date Issued: March 2015

- Operations Manager
- Client Representative
- Company Safety Officer
- Field Supervisor
- Other personnel, consultants and specialists as may be required.

Accident Outcome
Asset
Environmen
Damage
t
Death(s)
N/A
N/A
Mayor
Extensive
Mayor
Lost Time
Mayor
Substantial
Minor
Minor
Minor
Injury

Ranking

Approval

Fatality
Mayor
Serious
Minor

DoD
Ops. Mngr.
CSO
Supervisor

Investigation Team
OM, CR, CSO, FS, Other
OM, CR, CSO, FS, Other
CR, CSO, FS, Other
CSO, FS, Other

4.6

The Investigation Report, as Attached, shall be filled out in its entirety and no details
shall be omitted.

4.7

The OM shall be responsible to ensure that any recommendations by the Internal

Audit/Investigation team shall be followed dup and measures implemented as
required and by the time specified.

4.8

The CSO shall ensure that all departments and personnel are informed of any
changes.

4.9

The CSO shall retain the originals of the report and file as per the File Management
System.

INCIDENT CLASSIFICATION
5.1

5.2

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Accidents
5.1.1

Accident with Injury

Incidents which results in an injury, however caused, to Company or third
party personnel

5.1.2

Accident without Injury

Incidents involving people, assets or the environment which are not a near
miss in which no injuries occurred.

5.1.3

Occupational Illness
Any work related abnormal condition, disease or disorder, mainly or wholly
cause by the work environment. Occupational Illnesses are distinguished
from work related injuries in that injuries usually occurs as the result of a
single event, whereas occupational illnesses usually occurs after prolonged
or repeated exposure to substances or due to the environment or
ergonomics.

5.1.4

Near Miss
An incident in which there was no significant outcome, i.e. injuries, damage
etc., but in which the potential for injuries or damage existed.

Incident Class

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5.3

Document Control No.

PEI-QHSE-003
Revision : 2
Date Issued: March 2015

5.2.1

Fatality
A death resulting from a work injury regardless of the time intervening
between the injury and the death.

5.2.2

Lost Time Injury

An injury as a result of which the injured person is unable to perform any
regular job, or restricted job, on the day after the day on which the accident
occurs.

5.2.3

Restricted Work Case

An injury which results in a work assignment the day after the injury occurred
that does not include all the duties of that persons regular job. The restricted
job shall be meaningful, pre-established or a substantial part of a regular job.

5.2.4

Medical Treatment Case

An injury where, after receiving medical treatment, the person returns to his
regular job. In such case subsequent visits to the physician for follow up
treatment are normally required. Overnight stays in a hospital, for observation
is included as long as the person can resume his normal duties the day after
the incident.

5.2.5

First Aid Case

Minor injury where a one time treatment is normally sufficient and which do
not include normal medical care such scratches, burns, splinters etc. Such
treatments are considered first aid even if provided by a physician or licensed
medical personnel.

Incident or Potential Incident Severity Assessment

5.3.1

Initial Assessment
a) The initial assessment shall be made at the time the accident or incident
is first reported.
b) The Incident reporter shall assign a number of 1 to 5 to indicate the
potential severity of the incident, based on the values and criteria as
listed in Attachment A, for the categories People (P), Assets (E) or the
environment (E).
Sample: 3(P), 1 (A), 1(E)
The categories shall be listed started with the highest rating followed by
the lower ones in decreasing values.
Sample: 2(E), 1(P), 0(A)
c) Assessment of potential incidents shall be based on the same criteria as
for actual incidents.

5.3.2

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Actual Severity

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ACCIDENT AND INCIDENT

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Document Control No.

PEI-QHSE-003
Revision : 2
Date Issued: March 2015

a) The actual severity shall be the measure of the incident or accident,

determined after full evaluation.
b) The severity reported shall be based on the same criteria as for initial
assessment.

ATTACHMENT A
ALOCATION OF INCIDENT SEVERITY
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QHSE MANUAL

Document Control No.

PEI-QHSE-003

ACCIDENT AND INCIDENT

REPORTING

Revision : 2
Date Issued: March 2015

GUIDE FOR ASSESSMENT

P.

INJURY TO PEOPLE
1.
2.

Slight Injury requiring no, or only minor first aid treatment.

Minor injury probably requiring at least first aid treatment and possibly requiring
treatment by a medic or doctor

3.

Major injury, probably involving significant medical treatment

4.

Single (or up to 3 closely grouped) fatalities or permanent total disabilities

5.

Multiple (or wide spread) fatalities.

A.

MATERIAL DAMAGE
1.

Slight damage with no disruption in the process or operations.

Repair and consequential damages less than USD 10,000

2.

Minor damage with some remedial work required and loss of process or disruption of
operation of less than 24 hours.
Repair and consequential damages less than USD 100,000

3.

Localized damage with partial shutdown of facilities without major disruption of process
and operations.
Repair and consequential dames less than USD 1,000,000

4.

Major damage with partial loss of faculties resulting n process shutdown and loss of
operations for some time.
Repairs and consequential damages less than USD 10,000,000

5.

Massive and extensive damage with substantial or total loss of process and operations.

E.

ENVIRONMENTAL DAMAGE
Environmental
Impact
1

Minimal
Minor with no
lasting effects
Localized

Major

Massive

Halon & CFC

release

Clean-up Cost

Operating Upset
HC Venting

Operating Upset
HC flaring

< USD 1,000

< 50 kg.

< 1.4 MM M3

< 1 MM M3

USD 1,000 to 10,000

50 100 kg

>1.4 to <7 MM M3

> 1 to <5 MM M3

USD 10,000 and 50,000

USD 50,000 to
1,000,000

> 100 kg

>7 to <14 MM M3

> 5 to <10 MM M3

Repeatedly >100 kg

>14 to <35 MM M3

> 19 to <25 MM M3

> USD 1,000,000

Frequent>100 kg

> 35 MM M3

> 25 MM M3

ACCIDENT & INCIDENT REPORT

REPORT NO.
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WORK RELATED
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NON-WORK RELATED

QHSE MANUAL

ACCIDENT AND INCIDENT

REPORTING

Document Control No.

PEI-QHSE-003
Revision : 2
Date Issued: March 2015

INCIDENT CLASSIFICATION
INCIDENT CATEGORY
INCIDENT CLASS
Accident with Injury
Fatal
Accident without Injury (Material Damage only)
Lost Time
Accident with environmental damage only
Restricted Work
Occupational Illness
Medical Treatment
Near Miss
First Aid
DETAILS OF INCIDENT
DATE

TIME

SEVERITY
Actual
Potential (Initial Assessment)
NAME

LOCATION

SEVERITY (ACTUAL OR POTENTIAL)

(P) - People
(A) - Assets
1 2 3 4 5 1 2 3 4 5

PERSONNEL INVOLVED / INJURED

POSITION

(E) - Environment
1 2 3 4 5

INJURY

1
2
3
4
5
6
VEHICLES / EQUIPMENT INVOLVED
VEHICLE / EQUIPMENT MAKE
REGISTRATION NO.
1
2
ONE LINE SUMMARY OF THE INCIDENT

INCIDENT REPORT NO.

FULL DESCRIPTION OF THE ACCIDENT
(Use Attachments if Required)

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DAMAGE

QHSE MANUAL

ACCIDENT AND INCIDENT

REPORTING

SKECTCH
(Use Attachments if Required)

INCIDENT REPORT NO.

IMMEDIATE ACTION AFTER THE INCIDENT

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Document Control No.

PEI-QHSE-003
Revision : 2
Date Issued: March 2015

QHSE MANUAL

ACCIDENT AND INCIDENT

REPORTING

Document Control No.

PEI-QHSE-003
Revision : 2
Date Issued: March 2015

HOW COULD THIS INCIDENT HAVE BEEN PREVENTED

ADITIONAL RECOMMENDATIONS TO AVOID RE-OCCURANCE

This Incident Report Sent To:

This Incident Report Copied To:

INCIDENT REPORT PREPARED BY:

INCIDENT REPORT REVIEWED BY:

NAME

NAME

POSITION

POSITION

SIGNATURE

SIGNATURE

DATE

DATE

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