SAFETY ALERT

Stage – 1

Incident Date/Time: 02/27/2020 08:42am Operation: North America Alert # 202003

Incident Type: High Potential Incident – Loss of Production Rating: Moderate
Incident Location: Between 4th bay and Shipping and Receiving
Author: Dawn Dean Date: 02/27/2020

Incident Description:
Employee was driving a forklift, moving a truck body on a dolly and ran into and broke the natural gas
supply line to the workshop.

Photo or Diagram:

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Stage – 1

Immedediate Actions Taken:

Gas company shut down production. No injuries were incurred so we moved directly into investigation.
The forklift operator was sent for a post incident drug screen and alcohol test. Photos were taken and
interviews were conducted with the operator and witness.

Action Completed
Immediate Actions Taken - Plan
Sign: Date:
Production stopped for an undetermined amount of time – All pipes in the
workshop have to inspected for damage and re-certified by the utility company
prior to commencement of work.
ICAM Investigation to be completed 2/27/19.

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Incident Date: Operation: Incident #

Incident Type: Rating:
Incident Location:
Incident Severity Incident Severity
Rating (Actual): Rating (Potential):

Incident Discription:

Root Cause:

Contributing Factors:

Key Learnings: (what other BU’s should consider)

Photograph/s:

Operations Manager:
Business Unit Leader:

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