SOL – Lessons Learnt Alert

Mass Food Poisoning

Details of Incident / Accident: - for information, communication and consideration

An incident occurred on a SOL Project where a larger than normal night shift was seconded to complete certain key
works on site to boost construction. Arrangement and agreements were made to ensure the smooth and safe running
of the proposed night shift, specifically food arrangements where night shift workers would have hot meals at their
camp, prior to starting the night shift and a cold meal or a sandwich for their midnight meal at site.

However, this agreement and instruction was ignored and hot meals were brought to site at 6pm on the evening of 9
Feb 2013 and were only given to workers the next morning at 12am. At around 1:30am, the site clinic started getting
its first few patients complaining of abdominal pain. Once the patient count started to climb severely, the nurse
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contacted the Site Doctor, who immediately instructed for the dispatch of all patients to hospital, fearing that there
might be a case of mass food poisoning.

A total of 79 persons fell ill, 33 of which were discharged within an hour of arriving at the hospital with no prescription
medication given. However, the remaining 46 patients were kept in hospital overnight and put on medication, by the
morning of 12th February 2013 all 46 admitted patients were discharged from the hospital with a clean bill of health.

Possible Causes of the Accident / Incident:

1) Hot food intended for the camp was not being held in hot holding cabinets prior to dispatch to the camp dining
facility. Consequently, there was no assurance that food would be served above 60C or within 2 hours of it
dropping below this temperature as specified by guidelines (the food had been produced at 9am in the morning).
As a result, the procedure being adopted was found to be hazardous (potential food poisoning).
2) No food safety management system was in place within the kitchen of the Caterer. There is no method of
assuring the safe production, transportation or service of food to the camp.
3) Wash basins are severely lacking at the camp kitchen. As a minimum, wash hand basins shall be provided to
the butchery, bakery, vegetables preparation areas and cooking areas.
4) Food was contaminated at the cooking stage as caterer failed to monitor cooking temperatures, this was due to
lack of a HACCP.

Corrective Measure Taken to Avoid Reoccurrence

1) Food Safety: Critical Stages of Operation (CCP) must be correctly implemented such as Transportation of
prepared food outside camp, Monitoring of Temperature Control, Cleaning Arrangements, Salad Fruit &
Vegetable Disinfection, Preventing Chemical Contamination of Food, Food Safety Training, Maintenance of
Facility & Equipment and Food Safety Audit.
2) An approved 3rd Party caterer to be assigned to completely take over full management of camp (food, hygiene,
maintenance, laundry, etc).
3) No food to be sent to site from camp.
4) SOL Contracts Department needs to ensure caterers have HACCP plans to meet SOL, SAG and client
requirement prior to securing

Stop! Think! Then Act!-

Stop accidents before they stop you

Issue Date: 12 March 2013 Incident Alert No.: SOL-HSE-IA-120313