INCIDENT, NONCONFORMITY AND CORRECTIVE ACTION MANAGEMENT

OHS-PR-09-26-F01 INITIAL INCIDENT NOTIFICATION 26.1

Operating Area: COA Department: PDC

Project Name: SS 8358 Misk
Contractor Name: Al Babtain Project Type: 132 KV Contract No.: PTS-20CN190

General Information: ISD

Number :
Name: Nazeer Job Title: Mason Badge No: 15225
Incident Date: 08/01/2022 Incident 8:30 Am
Time:
Persons Involved: SEC Employee Contractor Employee Third Party
Vehicle Information (if applicable)
Model: Plate No: Vehicle ID: Number of vehicle
involved:
Area: Southern side of substation Location: Substation site SS8358
Company: Al Babtain Business Line: Projects
Sector: Construction Department: Construction
Division: Construction Workplace Manager: Farouk
Incident Type: Nonconformity Near Miss Incident Fatality Lost Time Injury MTC
Property Damage Power Failure Vehicle Incident Fire
Incident Level: Level I Level II Level III Level IV
Investigation Type: [ Formal Root Cause Analysis ][ 5 Why RCA ] [ Initial Report Only ]

Incident Information:
Incident/Nonconformity Description:
(The description of the Incident must outline who was involved, what occurred and when did it occur)
On Saturday 8/01/2022 at 9:30 Observed the worker was working closely with un protected steel rebar which can
cut , scratch , pierce and impale the worker causing internal serious injury or death .

Attach Sketch/ Pictures of/or Photos if available:

Reported Corrected

OHS Forms  Procedure Reference Revision Number Revision Date Approved By

INITIAL INCIDENT NOTIFICATION 26.1 OHS-PR-09-26-F01 0 01 MAY 2021 OHSMS
 INCIDENT, NONCONFORMITY AND CORRECTIVE ACTION MANAGEMENT
OHS-PR-09-26-F01 INITIAL INCIDENT NOTIFICATION 26.1

Operating Area: COA Department: PDC

Project Name: SS 8358 Misk
Contractor Name: Al Babtain Project Type: 132 KV Contract No.: PTS-20CN190

Immediate Corrective Action:

(This is the first action taken by either the persons involved or the Area Supervisor / Manager)
Provided mushroom caps to protect steel rebar edges and to avoid any incidents. Also, TBT conducted to workers
about the hazards of working in unsafe area.

Reporter name: Elshafie Signature: Date: 8/01/2022

Accident responsible person: Abdularahaman Signature: Date: 8/01/2022
 

OHS Forms  Procedure Reference Revision Number Revision Date Approved By

INITIAL INCIDENT NOTIFICATION 26.1 OHS-PR-09-26-F01 0 01 MAY 2021 OHSMS