REPORT of INJURY

INCIDENT
SEVERITY:

IMPACTED ELEMENT:

Project Dept (Bonatti Contractor)

###
HQ / SUBSIDIARY:

FUNCTION AND DEPT.

JOB CENTER

INJURED PERSON NON

NAME

SURNAME

REGISTRATION

EVENT LOCATION

COMPANY

Bonatti Storage Yard

in case of INJURY
in ITINERE YES

EVENT N 2016-INC-15

A) JOB
WAREHOUSE WORKER
ELECTRICAL MAINT.

WIRE- LINE PERSON.- W/O

MANAGEMENT

MECHANICAL MAINT.

SUPERVISOR

HIRED in YEAR

INSTRUMENTATION MAINT.
LABORATORY PERSONNEL

TECHNICIAN
VISITOR

ABANDONMENT DATE

JOB SENIORITY

OFFICE PERSON

DRIVER
OTHER (Specify)

WORK SHIFT
1
2
ACTIVITY COVERED by
WORK PERMIT / RISK ASSESSMENT YES

AGE

MARINE CREW

27/10/2016

INCIDENT DATE

PRODUCTION PERSON.

TIME

NO

03:50PM

27-10-2016
3

D
NO

EVENT DESCRIPTION
A container loaded with new pipes for mitigation project (approximately 26 tons) was collapsed during handling and lifting process by crane at
Bonatti Storage Yard
. The improper lifting techniques (i.e. shortness of slings, unbalanced load center and/or stress within the container body) were almost the main
reasons. There were no injuries. Some damage was occured to the container body and truck.
The attached pictures illustrate the situation.

B) EVENT LOCATION

C) EVENT SITE

D) ACCIDENT TYPE

E) CONTINGENT EVENT

GAS / OIL PLANT

WELL HEAD AREA

COLLISION WITH

FALL of OBJECTS

ELECTRICAL EQUIPMENT

DRILLING SITE

PROCESS PLANT

HIT BY

OBJ. IMPROPERLY PLACED

WELDING/CUTTING

CONSTRUCTION SITE
PRODUCTION PTF.

TANK AREA
RIG FLOOR

CRUSHED BY
RUN OVER BY ...

HAND TOOLS
MATERIALS HANDLING

ADVERSE WEATHER
WHEELS, DRILLS, LATHES

DRILLING PTF.

YARD

CUT

INSTRUMENT MAINTEN.

VEHICLES/EQUIPMENT

PTF. IN CONSTRUCTION

WORKSHOP

EXCESSIVE PHISICAL STRAIN

DESCEND from VEHICLES

WORKING SURFACE/FLOOR

MAIN OFFICE

INSTRUMENTAL/CHEM. LAB.

FLAT FALL

OPERATIONS in ELEVAT.

ROAD ACCIDENT

ROAD

ELET: CAB/CONTROL ROOM

FALL FROM HEIGHT

STAIRS & SCAFFOLDING

ROAD CONDITIONS

WELL

WAREHOUSE

SLIPPED / TRIPPED

TRANSFERRING FLUIDS

OTHER (Specify)

SUPPLY BASE

KITCHEN/QUARTERS

INHAL, INGEST, ABSORB.

TRANSFERRING PEOPLE

OTHER (Specify)

OFFICE

CONTACT DANGEROUS SUBST.

OWN VEHICLE

CONTACT H/L TEMP.

COMPANY VEHICLE
PIER
THIRD PARTY VEHICLE
OTHER (Specify)

ELECTROCUTION
ON BOARD / DRIVING...
OTHER (Specify)

G) TREATMENT SITE
COMPANY SURGERY
EXTERN. MEDICAL SURG.
HOSPITAL

F) INCIDENT TYPE
FIRE
EXPLOSION
TOXIC SUBSTANCES RELEASE
STRUCTURES COLLAPSE
SPILL/DISCHARGED

PLANE CRASH
NAVAL ACCIDENT
TRIPS/SLIPS AND FALLS
OTHER (Specify)
OTHER (Specify)

Damage of container body

H) INJURIES LOCATION

I) INJURIES TYPE

HEAD

HAND/WRIST/FINGER

RESPIRATORY SYSTEM

WOUNDS

INJURIES from FOREIGN BODIES/SUBST.

FACE

BACK/SPINAL COL.

CARDIO VASC. SYSTEM

ABRASIONS

INJURIES from HEAT/COLD

EYE

ARM/SHOULDER

DIGESTIVE SYSTEM

BRIUSES and CRUSHING

INTOXICATION

EAR

FOOT/ANKLE

MULTIPLE HEAD/LIMBS

DISLOCATION, SPRAIN, STRAIN

AMPUTATION

NOSE

CHEST REGION

MULTIPLE HEAD/CHEST

BACKLASH

ELECTROCUTION

MOUTH

LUMBAR-SACRAL REGION

MULTIPLE CHEST/LIMBS

FRACTURE / INFRACTION

IONIZING RADIATION

NECK

ABDOMINAL REGION

MULTIPLE UPP/LOW LIMBS

CONCUSSION/ INTERNAL TRAUMA

SUFFOCATION / DROWNING

LEG

GROIN

OTHER (Specify)

STRAIN INJURY

MEDICAL TREATMENT CASE

MULTIPLE INJURIES

OTHER (Specify)

No Injuries

FATAL ACCIDENT CASE

REMARKS

1234-

It is highly recommended to implement a close supervision programme for any loading and uploading activitiy in future by competent person.
Lifting plan must be prepared and checked by competent person.
Carne drivers must be certified and trained appropriately to avoid any similar incident in future.
All people must be kept far away from any lifting activities.

WITNESSES

WORKING TEAM
OCCASIONAL

INJURED PERSON Signature (if possible)

REPORT COMPILER

Signature

Signature

SFM

DIAGNOSIS

FIRST PROGNOSIS

DEPARTMENT MANAGER

Kamal Atayari

HSE REPRESENTATIVE

Naji Alemari

SUBSIDIARY GEN. MANAGER

Abdulmonaim Farhat

REPORT COMPILATION DATE

SUPERVISOR

27/10/2016

MOG-HSEQ-F-085 Rev A4 Accident/Incident

Signature
Signature
Signature