KPC FIRST NOTIFICATION REPORT

DOCUMENT: RECORD Rev. NO:

SUBJECT: WORKPLACE INCIDENT REPORT Code No.
NO OF PAGES:
Field:
Salam DATE:
THIS FORM MUST BE COMPLETED BY SUPERVISOR
Reported by: Date and time: 11 6 2020 10:00 AM
Name Signature Day Month Year Time

Incident Category:
Fatality

Area/ Department (describe exactly where:) EDC Rig-41 on Goose 1x, Drilling Departement
Involved Person:
KPC EPESCO Contractor X
Incident Details:
Name of person(s) involved: 3 rig floor crew, Toolbusher, Driller, Asst. Driller, and Company Man
How did the Incident occur and immeidate causes: Loss Details (if applicable):
On 11/6/2020 at 10:00 A.M the deceased person was crushed between rig make
up tong and its make up line. The crushing act was due to the spinning of the TD Fatality
without activating the “TD Grabber” . STP decided to change the breaking out
sequence that had been followed since the shift beginning which is breaking stands
from rig floor first to be from top drive. Moreover, the change was not
communicated to rig floor crew. STP instructed A/D, who was in charge as the No. of days lost:
driller was at his tea break time, to break the TD connecton first.
Contributing Factors:
1. Breaking sequence was changed without notifying rig floor crew
2.The "Snub Line" was not installed. Snub line is a safety wire to restrict tong
movement
3. Long EZY torque wire that crushed the person was used instead of the snub line
Immediate / remedial Action Taken to Secure By Whome By When
Perform function test for the Grabber (Tested and working properly) Done
Install proper length Snub line EDC Immediately
Shortening the EZY tong wire EDC Immediately
Remove the makeup ezy torque wire before POOH and ensure the snub line is
EDC Immediately
installed at all time
Write a proper instructions for the TD breaking out emphasizing clearing rig floor
EDC A week
and engaging Grabber (Press and Hold)
The Report has been completed by Area Owner / Team Leader

Date
Name Signature Day Month Year
Feedback- I am satisfied with the level of investigation and close-out that has been put in place:
Field/Deputy Manger Date: YES NO x
Safety Manager Date: YES NO x

Comments:
This is a prelimenary report focusing on the immediate causes of the incident. The invesitigation is still ongoing to
determine the root causes and suggest recommedation to correct them. Final investigation report is due on 25th June
2020.