INCIDENT REPORT

REFERENCE FLASH REPORT

P2W-4021-OSH-0078-00_ELI P2W-4021-FLA-0078-00_ELI
POLIHALI TRANSFER TUNNEL PROJECT

Person reporting the incident must complete sections 1 – 6 on pages 1 & 2

1. Incident reporting person details

Name KENAUOE MPAPA Date of report 16/04/2024
Injury Property
Labour/
Nature of report / ☐ Environmental ☐ Loss/ ☒ Near Miss ☐ Community
☐
Illness Damage

Complete Parts 2 – 7 in case of an Injury/Illness or Part 8 in case of Property Loss/Damage

2. Details of the persons involved

Date of birth
First name KENEUOE

Surname MPAPA
N/A Gender
Other names
Male ☒ Female ☐
None
E-mail Phone No
Injured person(s) classification
but Occupation Industrial Engineer Employee No KKN-J0519

Project Area N/A Department Electrical

KKM-JV
Employer
Contact details 59105834

Experience in task being X

< 1 month 1–12 months 1–5 yrs > 5 yrs N/A
perf40ormed

Training in task being Internal task- X External task-

None Induction
performed specific specific

Surname Name
Visitor ☐
Host name
Public person ☐ Name (if provided) Add more sheets, if required

3. Witness details (complete if there was a witness)

First Name Employee No

Surname Telephone No

4. Incident details:
Date of event 13/04/2024 Time of event 11:00
Site Polihali Specific location Polihali–Workshop
Describe the incident (add more sheets, if required): Welding machine that was connected at power box Power Box 3 near
mechanical department storage, the machine oozes smoke and produces a blasting sound. The earth leakage circuit breaker
feeding the leakage also trips. The same time welding machine 3 at power box PB1 cable entry point produced a loud sound
from the same power box and a 3 phase (see through) circuit breaker connecting an unused drilling machine, in off position
seemed black within and both welding machines that malfunctioned are of the same size and brand. Printer from site clerk
office emitted smoke and produced a hissing sound quickly cuts power from the distribution board, resulting in damage to
the printer and plugs malfunctioning.

Page 1 of 4
 INCIDENT REPORT
REFERENCE FLASH REPORT
P2W-4021-OSH-0078-00_ELI P2W-4021-FLA-0078-00_ELI
POLIHALI TRANSFER TUNNEL PROJECT

1. No injuries were reported.

DOUBLE CLICK PAPER CLIP TO OPEN

5. Injury/Illness details
Nature of injury/illness Asthma or other respiratory illness ☐ Amputation ☐
or symptom Bruise, contusion or crushing injury ☐ Burn ☐

Dermatitis or other skin conditions ☐ Concussion ☐

Effects of exposure to the elements ☐ Dislocation ☐
Foreign matter intrusion ☐ Electric shock ☐
Needle stick or sharp injury ☐ Fracture ☐
Poisoning or effects of substances ☐ Internal injury ☐
Psychological ☐ Sensory loss ☐
Sprain/Strain ☐ Superficial injury ☐
Other (specify)
Ear ☐ Hand or finger ☐ Back ☐
Eye ☐ Internal organs ☐ Neck ☐
Location of injury/illness Face ☐ Feet or toes ☐ Shoulder or arm ☐
or symptom
Head (not ear/eye/face) ☐ Hip or leg ☐ Chest ☐
Multiple locations ☐ Not applicable ☐ Other
(specify)
Contact with ☐ Muscular stress from ☐
How did the injury, Exposure to ☐ Trapped between ☐
illness or symptom Fall from ☐ Trapped by ☐
occur?
Struck by ☐ Tripped over ☐
For example: Struck against ☐ Vehicle accident ☐
Fall from – stairs
Other (specify)

6. Sign and forward report to injured person’s (or area) supervisor/line manager
Supervisor/line manager N/A

Signature of injured person N/A Date N/A

Signature of person reporting incident N/A Date N/A

Injured person’s (or area) supervisor/line manager must complete section 7

7. Immediate response (correction)

Treatment to injured person provided by Nil ☐ First ☐ General ☐ Hospital ☐ Hospital ☐
aider Practitioner (out-patient) (in-patient)
Work time lost due to injury/Illness N/A

Immediate actions (correction) taken to prevent or reduce risk of recurrence/escalation

Elimination control
☐ Substitution ☐ Engineering X Administration ☐ PPE
☐
control control control
Detail of immediate response actions: Main switch at Power Box 1 and all earth leakage circuit breaker fed from it were
turned off.
N/A

N/A
Corrective Action Report (CAR) reference

Page 2 of 4
 INCIDENT REPORT
REFERENCE FLASH REPORT
P2W-4021-OSH-0078-00_ELI P2W-4021-FLA-0078-00_ELI
POLIHALI TRANSFER TUNNEL PROJECT

N/A N/A
Supervisor/line manager name
N/A Date
Signature

Complete Part 8 in case of Property Loss/Damage

8. Property loss/damage details

Welding machines, printer and light bulbs damaged

Environmental Incident details

Date of event N/A Time of event N/A
Specific
Site N/A N/A
location
Describe the incident (add more sheets, if required):

N/A

Spill ☐ Cultural Heritage disturbance/damage ☐

Waste/Rubbish ☐ Chemicals / herbicide Use ☐
Type of Incident Wildlife disturbance/injury ☐ Water pollution/contamination ☐
Vegetation disturbance/damage ☐ Nuisance (noise, air quality) ☐
Acid Sulphate Soils disturbance ☐ Other(specify) - Community Unrest ☐
Spill Details
Spilled material N/A Quantity spilled (litres) N/A
Area affected (m2) N/A Total response time N/A
Rock ☐ Grass ☐ Gravel ☐ Other soil (silt, clay) ☐
Surface Type
Concrete ☐ Pavers ☐ Sand ☐ Other ☐
Immediate actions (correction) taken to prevent or reduce risk of recurrence/escalation

Elimination control
☐ Substitution control
☐ Engineering ☐ Administration ☐ PPE
☐
control control
Detail of immediate response actions:
N/A

N/A
Corrective Action Report (CAR) reference
Supervisor/line manager N/A N/A
name
N/A Date
Signature

Page 3 of 4
 INCIDENT REPORT
REFERENCE FLASH REPORT
P2W-4021-OSH-0078-00_ELI P2W-4021-FLA-0078-00_ELI
POLIHALI TRANSFER TUNNEL PROJECT

Identify Risk / Loss Potential Using Risk Assessment Matrix

Likelihood of Recurrence of Event Consequence / Severity
1 – 10k / 10 – 100k / 100k – 1m / 1 – 10m / ˃10m /
Health & Safety Minor Injury Temporary Permanent Fatality Multiple
Disability Disability Fatalities
Minor On site On site Off-site On or offsite
localized release, release, release, spill causing
spill or immediately contained & contained & environment
damage with contained & restored, having al pollution
insignificant restored, medium-term medium term with
Environment effects on with short- effects on effects on detrimental
employees/ term effects employees/w community long-term
community/ water health and effects
natural sources/soil the natural
environment s and air environment
quality
Low 5 Minor 4 Moderate 3 Major 2 Critical 1
1 or more times per week Almost Certain Moderate ☐ High ☐ Extreme ☐ Extreme ☐ Extreme ☐

Occurs once per month Likely Moderate ☐ High ☐ High ☐ Extreme ☐ Extreme ☐
Occurs once per year Possible Low ☐ Moderate ☒ High ☐ Extreme ☐ Extreme ☐
Occurs once every 10 Unlikely Low ☐ Low ☐ Moderate ☐ High ☐ Extreme ☐
years
Occurs once in a lifetime / Rare Low ☐ Low ☐ Low ☐ Moderate ☐ High ☐
100 years
Risk Level Investigation Requirements
Low Risk Casual Incident Investigation Supervisor
Moderate Risk Casual Incident Investigation Line Management
High Risk RCAT Investigation Middle/Senior Management
Extreme Risk RCAT Investigation Senior Management / MD

The SHEQ Manager / Officer / Appointee must complete section 9

9. Classify the incident based on criteria listed in Incident Investigation Procedure

Low Minor Moderate Major ☐ Critical ☐
Comments:
Mitigation Actions
IMMEDIATE CAUSES:
1. FOLLOWING PROCEDURE/PRACTICES/RULES/STANDARDS – Failure by artisans to test machines for expected
frequency and rpm at approximate 50HZ and 1500rpm.

2. FOLLOWING PROCEDURE/PRACTICES/RULES/STANDARDS – Failure to test for standing faults circuit by circuit on all
energized power boxes.

ROOT CAUSES: Blown components in the welding machines which are electronics that safely dissipate large
amounts of surge energy over voltages.

CORRECTIVE ACTIONS
1. Ensure all power boxes and distribution boards are fitted with Plant Manager MR Langano
surge protection devices as per SANS 10142-1

2. Ensure that daily inspections are conducted on machines.

Electrical Foreman
3. Hold an incident re-call with Welders and electricians
Safety Officer Lefa Thamane

Page 4 of 4
 INCIDENT REPORT
REFERENCE FLASH REPORT
P2W-4021-OSH-0078-00_ELI P2W-4021-FLA-0078-00_ELI
POLIHALI TRANSFER TUNNEL PROJECT

Assigned Investigation Facilitator Name

Name Lefa Thamane
Date 16/04/2024

Signature

PHOTOGRAPHIC EVIDENCE

Page 5 of 4