INTEGRATED GAS PROJECT HABSHAN 5

UNPLANNED EVENT 0-60-120 MINUTE INITIAL NOTIFICATION (Rev 05)

IGP JV HSE OFFICE
NOTIFICATION DATE: DD/MM/YYYY
LIKELY INJURY CLASSIFICATION

10

07

2011

(IF APPLICABLE)
Mark

NEAR MISS POTENTIAL/ASSET DAMAGE CLASSIFICATION (IF APPLICABLE)

Mark X Where applicable:

X Where applicable:
MTC RWC LTI FAT OI

(Classification According to S-000-1654-019_1)

FAC

(Classification According to S-000-1654-019_1)

NEAR MISS POTENTIAL LOW MED HIGH APPROXIMATE ASSET DAMAGE (USD)

X
FIRE ENV SECURITY RTA

1
10,000

<

2
< 100,000

3 +/500,000

4 +/-

5>

10,000,000 10,000,000

JGC

TCM

SUBCONTRACTOR DESCON

X
Name of Injured (If Irshad Ahmad Applicable) Name of Rana Perviz Supervisor Occupation: Location Fabricator

Date of Event: dd/mm/yy

10

07

11

Time of Event: (24hr) 00:00

11

30

Type Of Asset Name of Operator (If Applicable) 2nd or 3rd Party Asset Involved Location

E 300 Pipe Rack

KNOWN DETAILS
Brief Description of The INJURY Event or ASSET Damage (As Applicable) On 10th July, 2011 at about 1130 hours at E 300 pipe rack first elevation, IP was doing marking for pipe supports mean while a wooden piece of approximatly 1 meter long fell down from the scaffolding opening of second elevation and touched the left hand ring finger thereby IP sustain a skin cut.

Parts of body injured (CIRCLE)

Brief Description of The Injuries (If Applicable)

N/A

Brief Description of Immediate Medical Treatment (If Applicable)

N/A

Further Treatment Required: (Mark X Where Applicable)

YES

NO

Transfered (Location if Applicable) N/A

Transfer Time: 00:00 Format

DESCRIBE ANY IMMEDIATE CORRECTIOVE ACTION

Work stopped. Area made safe.

A Detailed Report According to Procedure S-000-1654-019_1 is to Follow within 8 hrs or by the end of the next working day:

This Report Prepared By: (Signature Not Required) NAME M.H.KHAN POSITION HSE MANAGER PROTOCOL NO. :