INCIDENT NOTIFICATION FORM

Short Description of Incident

location:
Date Reported: 26 April 24
Date Occurred: 26 April 24
Reported By: Engr. ADEMILUA BOSEDE
Incident Type: Hot Water Burn

INCIDENT SUMMARY
The Incident occurred at about 050:00 pm, works commenced and Mrs Elizabeth the sous chef was sharing her
experience with her colleagues during the working out and she forget that oil spillage on the floor as she kept
talking and discussing about her engagement and also hoping to be the next head of chef in the next year. Not
quite long like 5seconds she turn and carry the deep fries pot on the fire full of hot water and her right leg slipped
on the oil while holding deep fries full of hot water and the water poured on her face and also splashed down to
her neck and collarbone, longside she hitting up the gas switch which triggered the fire hitting system putting
everyone to a work stop when the water sprinkled, her colleagues raised the alarm and called the security
personnel on duty an also attention of the HSE Officers, only one person was injury encountered.

IMMEDIATE RESPONSE ACTION TAKEN

1. The colleague raised the alarm.
2. The HSE Officers on-site were called immediately

IMMEDIATE CAUSES FINDING:

1. Poor technique in man power.
2. Oil droppings on the floor.

INCIDENT FINDINGS
1. Prior to the Burning incident, Oil spillage on the floor.
2. Testimonies reveal the sudden incident that led to lack of concentration.
3. The fire incident cause series of isolation in the Restaurant.
4. The ignorance of workers not paying attention to wet floors as a result of the Oil,

FURTHER ACTION RECOMMENDATION

1. Employee trained and authorized personals
2. Ensure first aid team are always Ready
3, Provide enough personnel to carried out the work effectively
was sharing her
or as she kept
next year. Not
er right leg slipped
plashed down to
ystem putting