AL KARAM AL ARABI FOR CATERING SERVICES LTD

Incident Notification Form FM/HO/HSE/035

Date of
Project /Department: Central Kitchen 17/Dec/2023
Incident:

Time of
Place of Incident: Hot Kitchen 4:56 PM
Incident:
Injury ✘ First Aid Fatality Near Miss

Motor vehicle accident Food Spoilage Food poisoning

Incident Category
Quality ✘ Fire Incident Property Damage

Customer complaint Other______________________________

Involved employee(s)
Walli Ullah Arab
Name:

Employee ID: K2077 Civil ID: 290010171514

Designation: General Cleaner

Vehicle Details
(If applicable)

An incident occurred yesterday at approximately 4:56 pm in the

central kitchen involving one of our employees, Walli Ullah Arab
(Employee Number: K2077). He turned on a gas burner and
momentarily left to change the gas cylinder, inadvertently leaving
the burner open. Upon his return, he attempted to light the burner
Description of
using paper/carton, resulting in fire flames . Unfortunately, this
Accident / Incident/
complaint: led to minor injuries on his face and arms.

Immediate action was taken to provide with first aid by our Head
Chef Adam Rawoof, and emergency services were not required as
the injuries were minor. Later Kitchen Supervisor took him to the
hospital for mandatory check-up.

Injury: ✘ YES NO

Medical attention
✘ YES NO
required:

Injury Details, if any: Minor face and body burns.

Property Damage: YES ✘ NO

Damage Details, if any:

Doc. No. FM-HO-HSE-035 Rev.01 Date: 31-03-2022 Page 1 of 2

 AL KARAM AL ARABI FOR CATERING SERVICES LTD
Incident Notification Form FM/HO/HSE/035

Notification Issued by: Muzaffar Ahmad Designation QHSE Officer

Note: For major or serious accidents, investigation report will be issued after investigating with all involved parties.

Doc. No. FM-HO-HSE-035 Rev.01 Date: 31-03-2022 Page 2 of 2