Safety Alert February 2013 #3

What occurred? ACCIDENT KEY 'hat2 3evel back the ducting INFORMATION
surface with hammers 'here2 "OGO 'hen2 2545242567, 8265$m 1onte.t2 lternator ,ns$ection

ctivities2 3ifting the ventilation duct of the Generating Set G2

On Monday February 25th, while lifting the ventilation duct of the Generating Set G2, the end flange got a slight surface damage due to a blocked screw. mechanical maintenance technician wanted to level back the ducting surface with hammers. !nfortunately, he missed his target and the hammer hit one of his fingers, left hand. "he latter continued to work and only noticed that he was in#ured on that same finger u$on removing his gloves. minor fracture was diagnosed. "he doctor recommended % days off to facilitate the worker&s treatment and recovery, but also stated that the worker could go back to work $roviding he would do light tasks only. "he worker went back on site the following day and was given restricted duty.

Identified causes (based on 5 'hy&s analysis attached(

"here was one screw left and not removed before lifting the first half of the ducting, resulting in a damage of the end surface. "he worker used 2 hammers, one below and one above, to hit the blocked screw, which is not a$$ro$riate. "he worker reacted $rom$tly and didn&t take the time to think about the methodology or to discuss it with his su$ervisor before starting the #ob. )o a$$ro$riate control or su$ervision during the dismounting $hase. )o $ro$er communication between the team leader and the technicians. "he instructions given to the em$loyee to wait and not to do the #ob was not received $ro$erly due to noisy environment in the engine hall.

Actions
*rior to such un$lanned activity, the team has been instructed to review all the ste$s. +efore embarking in such un$lanned activities, to ensure that the technicians are fully aware of the $rocedures. ,m$lement a checklist for the critical tasks. -nsure that either the main tasks are done by e.$erienced technicians or closer su$ervision for these technicians. ,nvestigation on the $ossibility of having ear defenders with integrated /0 radios.

SAFETY INFORMATION
https: contour!lo"al#sharepoint#co$

Monthly re$orts

Lessons learned
+efore embarking in un$lanned activities, to ensure that the technicians are fully aware of the $rocedures. ,m$lementation of $ro$er checklists for critical tasks. 'hen a worker is sent to the hos$ital following an incident, a 1G res$onsible $erson must accom$any the April 2013

Yves-Arnaud Peres HSE Director

latter. "his is to ensure that the doctor understands the working environment of the worker so that a$$ro$riate recommendations can be $rescribed.