SEC 5-STAR SAFETY Saudi Electricity Company

Initial Report (4.2.1)

Accident Type: Fire Fatality njury DPropertyIDamage O Near Miss O Outage

Accident Class: O Major Medium OMinor

High Red Red Yellow White

Medium YMow White

Red Red
-high
Medium Yellow YellowYellow White

Low White White White White

Medium Medium Low

High high
Loss Potential Severity

Accident General Information

Injured Name: .Saukat Ai Job Title:in.R.an ID#. ...
2t855T5592
O SEC Employee Contractor Employee

Shift Time: aAM Morning Evening

Task:.Gaund.aS`emblg..a.Sage.
CYa SS AYm
Experience (Year).. A . . *******

Operating Area:.Rusadh.id Business Line:. **************

..Sector:.38a....aHTL

Department..R.Xas.ks Location:.i.ddida.
Vehicle Information(if applicable)
Model: * ..
***n* Plate #:... :VehicleID:... Number of vehicle involved:...

Over Time yes No Reporting Date..2.5.l.a.s.1.2c 2e Accident Date.2.5.s6.l.2et

Over time
hours. . Reporting Time:..yening Morning AccidentTime Evening Morning

Accident Description
..Rntiahgd...abak.as..t.ks....a.e.lilasi..SAN.han
in.S..ausk.x.akas..hs..eSk.e..ak..h..se A
...heaboa.ias..Yanisel.r...Xam.... as.b...in
Salma.hasf.ka.a.k.s..AAbee..ak.khs...Lefer
.n.R..an .e...as...n.a.Ja.sd..skaths...ASker.kka.k..e...
wet hame fY Yest at il:3 AA
Reporter name: .hales..khali.fa Signaturer Date..25ah.12a7
Accident responsible person: Kkale.d...si signature:..Kka Date.26l3s2s

4.2 Accident reporting and investigation | Safety and Health Management System (5-Star) 13 -15
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