Document No. Revision No.

Date Compiled Date of Next Review
SHE/PRO/DOC/4.5.3.1 01 November 2016 November 2017

Incident/Non-conformance descripton
Date of Incident/Non-conformance

Incident or Non-conformance
Immediate acton taken
Reportng Month

Reported by

Area
No

Cleaning
ITSOSENG Celling has and Non
Aug-16 22-07-16 SHE Rep WATER PLANT fallen removing Conformance
the debris

ITSOSENG Non
16-Aug 22-07-16 SHE Rep WATER PLANT Delapitated Conformance

ITSOSENG Non
SHE Rep WATER PLANT Broken Conformance
Aug-16 22-07-16
MAFIKENG
WATER Non
SHE Rep Roof leaking
TREATMENT Conformance
PLANT
5/8/2016
MAFIKENG
WATER Door handles Non
SHE Rep TREATMENT broken Conformance
PLANT
5/8/2016
MAFIKENG
WATER Non
SHE Rep Walls not clean
TREATMENT Conformance
PLANT
5/8/2016
MAFIKENG
WATER floor not Non
SHE Rep TREATMENT demarcated Conformance
PLANT
5/8/2016

5.3. Date Compiled Date of Next Review SHE/PRO/DOC/4. Revision No.Document No.1 01 November 2016 November 2017 MAFIKENG WATER Area not Non SHE Rep TREATMENT fenced Conformance PLANT 5/8/2016 Barricades MOLATEDI Non SHE Rep destroyed by DAM Conformance Hippo MOLATEDI Non SHE Rep No security DAM Conformance Purificaton MOLATEDI Non SHE Rep plant need to DAM Conformance be upgraded MOLATEDI Houses not in Non SHE Rep DAM good conditon Conformance MOLATEDI Non SHE Rep No lights DAM Conformance MOLATEDI Non SHE Rep DAM Broken glasses Conformance TSWASA Road to Non SHE Rep WATER forebay is Conformance SCHEME damaged TSWASA Balancing Non SHE Rep WATER resorvoir not Conformance SCHEME covered TSWASA Small house Non SHE Rep WATER and chemical Conformance SCHEME store leaking TSWASA Cracks at Non SHE Rep WATER meterhouse Conformance SCHEME building Wall of TSWASA chamber (2) at Non SHE Rep WATER balancing Conformance SCHEME resorvoir has fallen down MMABATHO Fittings and WATER switches are Non SHE Rep TREATMENT not in good Conformance PLANT conditon MMABATHO Lights not WATER Non SHE Rep working TREATMENT Conformance properly PLANT MMABATHO Waste not WATER Non SHE Rep removed TREATMENT Conformance regularly PLANT .

3.Document No. Date Compiled Date of Next Review SHE/PRO/DOC/4.5. Revision No.1 01 November 2016 November 2017 Mmabatho Rotatng Water Non SHE Rep machinery not Treatment Conformance qurded Plant Emergency Non SHE Rep MONTSHIOA door not Conformance 23/08/2016 fuctoning Blinds around Non SHE Rep MONTSHIOA offices not in Conformance good conditon 23-09-2016 Pump house Non SHE Rep GELUKSPAN door damaged Conformance Non SHE Rep GELUKSPAN Toliet damaged Conformance Sleeping house Non SHE Rep GELUKSPAN damaged Conformance fence and gate Non SHE Rep GELUKSPAN damaged Conformance DINOKANA Non SHE Rep WATER PLANT Walls damaged Conformance DINOKANA Windows Non SHE Rep WATER PLANT cracked Conformance DINOKANA Waste bins not Non SHE Rep WATER PLANT provided Conformance Toilets do not DINOKANA Non SHE Rep WATER PLANT have toilet Conformance paper .

Health. Medical. similar accident. None.3. N/A) Investgaton Required (Yes/No) (Required if Major.1 01 November 2016 November 2017 Acton required for effectve cl Correctve Acton (Acton taken to prevent the recurrence of Treatment Required (First Aid. Revision No. Incident Risk Category (Safety.Document No.5. incident or non-conformance) Moderate or high potental incident) Incident Severity Level Contributng causes Body part Injured Nature of Injury Environmental) Poor Implement Safety Medium None None None No maintena maintainance nce schedule for buildings None None Safety Medium None None None No Implement Old maintainance structure schedule for buildings Safety Low None None None No Replace all broken door handles Safety Low None None None No Clean Walls Safety Medium None None None No Demarcate the floor . Hygiene. Date Compiled Date of Next Review SHE/PRO/DOC/4.

Document No.5.1 01 November 2016 November 2017 Safety High None None None No Install fence Safety High None None None No Provide new barricates Safety High None None None No Hire security Safety High None None None No Upgrade plant Safety High None None None No Do maintanance of the houses Safety High None None None No Install lights Safety Medium None None None No Replace lights Safety High None None None No Fix the road Safety High None None None No Cover the reservoir Safety High None None None No Cover the leaks Safety High None None None No Cover cracks Safety High None None None No Rebuild the wall Safety High None None None No Repair fittings and switches Safety High None None None No Provide new lights Environmental Medium None None None No Remove waste regularly . Date Compiled Date of Next Review SHE/PRO/DOC/4. Revision No.3.

5. Date Compiled Date of Next Review SHE/PRO/DOC/4. Revision No.1 01 November 2016 November 2017 Safety High None None None No Provide quardrails Safety High None None None No fix the door Safety Low None None None No Replace blinds Safety High None None None No Replace the door Safety None None None No Repair toilet Safety High None None None No Build new house Safety High None None None No Replace fence and gate Safety High None None None No Rebuild the wall Safety Medium None None None No Replace windows Environmental Medium None None None No Provide bins Health Medium None None None No Provide toilet paper .3.Document No.

Document No.1 01 November 2016 November 2017 required for effectve closure Closed out by Final Sign-off by: Manager/Tea Leader (Name & Surname) Comments/Progress Update/Reference SHE Practtoner (Name & Surname) Due date for completon Responsible person Date of closure Date of closure Status District HR Officer Manager Overdue .5. Revision No. Date Compiled Date of Next Review SHE/PRO/DOC/4.3.

Date Compiled Date of Next Review SHE/PRO/DOC/4.5.Document No.1 01 November 2016 November 2017 ### . Revision No.3.

5.1 01 November 2016 November 2017 . Revision No.Document No.3. Date Compiled Date of Next Review SHE/PRO/DOC/4.

Yes MAFIKENG WATER TREATMENT PLANT First Aid First Aider Property Medium Chest Medical General DINOKANA WATER Medical Worker PLANT Quality Case Ears MOTSWEDI Minor HR Officer INTERMIDIATE Safety Injury Eyes Marketing LEHURUTSHE and OFFICE Near Miss Communic ations Face Officer/Pr (noise.Role Areas Players GELUKSPAN District Nature of Body Treatmen Investigati Manager Type Category Severity Incident Parts t on ITSOSENG WATER Disabling PLANT Injury Environm Electrician Incident ental High Arms None No MADIBOGO Non. actisioner mouth) MMABATHO WATER TREATMENT Property O&M PLANT damage Manager Fingers Ops Sup MOLATEDI DAM Theft Hands MONTSHIOA Vehicle Process Incident Controller Supervisor Head MOTSWEDI WATER TREATMENT PLANT None Regional Manager Legs Scheme Coordinat PHITSANE or Neck . Environm conforma ental Finance nce Health Low Boot First Aid.

Scheme REGIONAL OFFICE Supervisor None TSWASA WATER SCM SCHEME Trunks SHE Officer SHE Rep Stores Man Team Leader Technician TLB Operator Welder Service Provider .

SHE Officer V. Makhubel e SHE Manager E Ratshitan ga .

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