Doc. no. T-14.185.

289-SH16

SCDJV Rev. O Date 14/03/2022

Page 1 of 2
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Ref Doc. no. T-14.185.289

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SAFE BEHAVIOUR/GOOD
UNSAFE ACT UNSAFE CONDITION
PRACTICE
Date: Time: 9:20am Site/Location: PRECAST Project: JETTY 3,
LAYDOWN, AREA F PROJECT
Mr. Pepple Donald a worker slumped at about 9:20am on the 22 nd of
June, 2023, while he was waiting for concrete supply from batching plant
Describe the for precast slab work at the precast laydown area and was immediately
anomaly: rushed to the site clinic unconscious, after administering CPR BP check
which was 140/89mmhg, his oxygen rate was low he was transferred to
the Saipem clinic at about 9:36am. for further medical attention at
Saipem clinic.
Possible
Injury Environmental Damage/Spill Property Material Damage
consequences:
At 9:27am site ambulance left site clinic whereby he was transferred to
Immediate the Saipem clinic at 9:36am. For further medical attention at Saipem H
Action Taken: block clinic.

SITUATIONAL AWARENESS AND ADEQUATE REST SHOULD BE IMBIBE

Suggestion for AFTER CLOSE OF BUSINESS DAILY
improvement:

Reported by JOSIAH ISHEKE

(Optional):
Reported By / JOSIAH ISHEKE/ HSSE
Department
THANK YOU FOR YOUR CONTRIBUTION
BELOW SECTION RESERVED FOR HSE DEPARTMENT

High Medium Low

Notes:

Responsible for
close out:

Saipem Classification - General Use

 Doc. no. T-14.185.289-SH16

SCDJV Rev. O Date 14/03/2022

Page 2 of 2
HAZARD OBSERVATION CARD
Ref Doc. no. T-14.185.289

TICK THE LSR VIOLATED OR REINFORCED

Bypassing Safety Controls Confined Space Driving

Energy Isolation Hot Work Line of Fire

Safe Mechanical Lifting Work Authorization Working at Height

No Violation of Life Saving Rules

Saipem Classification - General Use

 Doc. no. T-14.185.289-SH16

SCDJV Rev. O Date 14/03/2022

Page 1 of 2
HAZARD OBSERVATION CARD
Ref Doc. no. T-14.185.289

HAZARD OBSERVATION CARD

SAFE BEHAVIOUR/GOOD
UNSAFE ACT UNSAFE CONDITION
PRACTICE
Date: Time: Site/Location: Project:

Describe the
anomaly:

Possible
Injury Environmental Damage/Spill Property Material Damage
consequences:

Immediate
Action Taken:

Suggestion for
improvement:

Reported by
(Optional):
Reported By /
Department
THANK YOU FOR YOUR CONTRIBUTION
BELOW SECTION RESERVED FOR HSE DEPARTMENT

High Medium Low

Notes:

Responsible for
close out:

Saipem Classification - General Use

 Doc. no. T-14.185.289-SH16

SCDJV Rev. O Date 14/03/2022

Page 2 of 2
HAZARD OBSERVATION CARD
Ref Doc. no. T-14.185.289

TICK THE LSR VIOLATED OR REINFORCED

Bypassing Safety Controls Confined Space Driving

Energy Isolation Hot Work Line of Fire

Safe Mechanical Lifting Work Authorization Working at Height

No Violation of Life Saving Rules

Saipem Classification - General Use