HSE name

Main contractor Incident Investigation

– LTI# - Date ofguidance
incidentnotes

HSE Investigation template and guidance

Non Accidental Death (NAD)

Confidential - Not to be shared

outside of PDO/PDO contractors 1
 HSE name
Main contractor Incident Investigation
– LTI# - Date ofguidance
incidentnotes

Process flow for investigations

Quality sign
Notification off
IRC/MDIRC

Kick off MSE3 IRC Minutes

Investigation
Reporting PIM action
draft
close out

Confidential - Not to be shared

outside of PDO/PDO contractors 2
 HSE name
Main contractor Incident Investigation
– LTI# - Date ofguidance
incidentnotes
Info to be established during Kick Off meeting
Remember guidance notes on bottom of slides
Incident Investigation Terms of Reference (ToR)

Investigation protocols - Documents to be used to investigation PR 1418

Incident Owner - Name and reference indicator
PIM No - XXXXXX
Investigation Team Leader - Names, reference indicators, role in investigation
Special terms - Special conditions/requirements of the investigation (e.g. joint PDO/contractor)
Subject Matter Experts – as required to be discussed during Kick Off meeting
Investigation deliverable - The team is responsible for investigating the incident and completing the following: Investigation
report , MD/IRC presentation, and learning pack.
Previous NAD - Previous incident, similar incident, including PIM No from company
Immediate Cause – Bring to kick off meeting for agreement
Critical Factors –
1.
2.
Investigation Team Members- Names, reference indicators, role in investigation

1. Investigation Team lead Name Reference Ind, Role, attend the scene (yes / no), HII (ICAM) trained (yes / no)
2. Name Reference Ind, Role, attend the scene (yes / no), HII (ICAM) trained (yes / no)
3. Name Reference Ind, Role, attend the scene (yes / no), HII (ICAM) trained (yes / no)

If not HII (ICAM) trained the contractor is to provide Incident investigator, level of competency assurance from senior
management.
NAD investigations should always include a medical professional.

Evidence repository must be provided electronically on data stick prior to MSE3 IRC

Confidential - Not to be shared

outside of PDO/PDO contractors 3
 HSE name
Main contractor Incident Investigation
– LTI# - Date ofguidance
incidentnotes

Timetable to be communicated during kick off meeting

• Incident classification, Critical factors, SME requirements, Timelines for reports

Rolling Days Action / Task

0 Notification received from MCOH
0-1 Initial Notification
1 Kickoff meeting
10* 1st Draft of report to MSE 3 representative  Review 1st draft return consolidated feedback
  2nd Draft of report to MSE 3 representative  Review of 2nd draft return consolidated feedback
21 Final revision for MSE IRC
23* MSE3 IRC
  Final report   QA / QC letter
30* Director IRC
42 MDIRC

* Escalation process milestones for not keeping to the timeline:

+3 days over due reminder 1 to Investigation Team Leader, HSE Team Leader and MSE 3
+5 days over due reminder 2 to Investigation team lead, HSE Team leader, MSE 3, MSEM and Director

Confidential - Not to be shared

outside of PDO/PDO contractors 4
Main contractor name – LTI# - Date of incident

Non Accidental Death

Name of Company
Date of Incident

5
 Name
Main contractor of –Company
name LTI# - Date and incident date
of incident

Incident details
PDO directorate/dept : (e.g. OSD /OSO/OSO4)
Contractor name/number : (subcontractor-contractor-PDO)/CXXXXXX
Incident owner : Name / Ref Ind of the Director
PIM ID : Number assigned in PIM
Location : Area / unit - (road/yard/station/rig/hoist/plant etc)
Incident date & time : (d/m/yr) / (24 hour clock) – advise if estimated
Incident type : Non Accidental Death (NAD)
Actual severity rating : 4P (as all NAD’s are already established)
Immediate cause of Death : Short description of what caused the death
Previous NAD : Include PIM number, short description of last (LTI/ NAD) of the
contractor, this applicable to all contracts with PDO
Key Mgmt Failure : Key Management system failure from conclusion slide including
ICAM number

Confidential - Not to be shared

outside of PDO/PDO contractors 6
 Name
Main contractor of –Company
name LTI# - Dateand incident date
of incident

Key Information about the deceased

Name of deceased

DOB and age

Nationality
Marital status and number of children. Including
their age and sex
Duration of service with the company:

Job title

Work schedule and date of last leave & leave cycle

(Days off)
HSE trainings and site induction

Confidential - Not to be shared

outside of PDO/PDO contractors 7
 Name
Main contractor of –Company
name LTI# - Date and incident date
of incident
Summary Description of the incident:

On -------------

Confidential - Not to be shared

outside of PDO/PDO contractors 8
 Name
Main contractor of –Company
name LTI# - Date and incident date
of incident
Details of the Medical Emergency Response (MER) :
Medical Emergency Response (MER) Yes/No Time to arrival Comments

Was 5555 called?

Was co-workers/bystanders involved initially?

Was First Aider(s) involved initially?

Was the Medic/nurse involved in MER?

Was a doctor involved in MER?

Was AED used and if so how long it took to start

What was duration of resuscitation?

(usually 30 min. minimum)

Was the deceased medevac (details)?

Other important comment(s)

Confidential - Not to be shared

outside of PDO/PDO contractors 9
 Name
Main contractor of –Company
name LTI# - Date and incident date
of incident
Details
Past Medical history: Yes/No

Major surgery

Chronic Medical condition(s) such as

Diabetes, high BP, Cholesterol, others

Allergies

Any Regular medications

Did the deceased attended the clinic or

had any complaints within 2 weeks of his
death during this work period?

At PDO
Medical examination: Yes/No Date done
approved clinic
Outcome -Fit /unfit/comments

Was Pre-employment examination

done?

Was fitness to work examination done? Fit or unfit?

Was periodic medical examination

Fit or unfit?
done?

Was Framingham cardiac risk done? ……..% Framingham score

Was Cardiac stress test (TME) done?

Confidential - Not to be shared

outside of PDO/PDO contractors 10
 Name
Main contractor of –Company
name LTI# - Date and incident date
of incident

Life style and social characteristics Yes/No Comments (E.g. quantity)

Was the deceased an active person leading a healthy lifestyle?

Was the deceased known to practice good dietary habits?

Was the deceased known to do regular exercise activities?

Was the deceased known to be a smoker /consume alcohol?

Was the deceased known to have drug misuse or drug issues?

Was the deceased notably obese? Weight ….………kg. BMI …………….

Was the deceased a quite/loner type of personality?

Was the deceased a friendly and always tend to mingle with

other people?
Was the deceased noted to have changed of behaviour in the
past 1 or 2 months before his death?.

Confidential - Not to be shared

outside of PDO/PDO contractors 11
 Name
Main contractor of –Company
name LTI# - Date and incident date
of incident
Work Environment: Yes/No Comments
Any known work environmental factors which
could have contributed to the death?

Any known chemical exposure from working

environment?
Any known biological exposure from working
environment?
Any unusual work related stress/fatigue?

Any other adverse work issue(s) worth noting.

Accommodation: Yes/No Comments

Was he staying alone or with roommate/s?

Was ventilation / air conditioning adequate?

Room lighting adequate?

Water and sanitation adequate?

Was food provision adequate?

When clearing the deceased room, was any

medicines or non-prescription drugs found?

Confidential - Not to be shared

outside of PDO/PDO contractors 12
 Name
Main contractor of –Company
name LTI# - Date and incident date
of incident

Contractual Health Management

(Find out about the health management in contracts within the direct working environment of the deceased)

Yes/No Comments / Gaps

Are all health risk assessments (HRA)

carried out and completed?

Are all work hazards exposure are being

monitored and managed?

Are health support and controls provided?

(In compliance with SP-1230, 1232) E.g.
Pre- employment, fitness to work, regular
check up and general medical care and
follow up.
Are regular health awareness and
education provided to all employees?

Is MER plan available and regular drills

conducted?
Include dates and content of drills

Are health activities included into the

annual HSE plans and are they monitored
by both contractors and PDO CH’s?
Does your accommodation / camp comply
with SP-1243?

Confidential - Not to be shared

outside of PDO/PDO contractors 13
 Name
Main contractor of –Company
name LTI# - Date and incident date
of incident

Conclusions:
Immediate Cause of Death

Underlying Causes of Death

Management system failure:

MSF Ref No # ICAM Mgt System Failure Description Justification for Management System Failure cited

14
 Name
Main contractor of –Company
name LTI# - Date and incident date
of incident

Key investigation findings: (List all the important findings)

1

15
 Name
Main contractor of –Company
name LTI# - Dateand incident date
of incident

Immediate actions taken if any:

No. Actions Date of action Status

*Immediate actions must be completed within 7 days of the incident

Confidential - Not to be shared

outside of PDO/PDO contractors 16
 Name
Main contractor of –Company
name LTI# - Date and incident date
of incident

Remedial Action / Recommendations:

No. Recommendations(Actions) Target Action Party PIM Action PIM Status Post action
Date (Contractor) Party (PDO) action Open/
verifier
No. Closed
for PIM
1

Confidential - Not to be shared

outside of PDO/PDO contractors 17
 PDO Second Alert
Main contractor name – LTI# - Date of incident

Date: Incident title: NAD

What happened?
Short description of what happened

Photo explaining what

Your learning from this incident.. was done wrong
(This must solely relate to the people at risk of harm or people at risk of causing the
harm)

• Learning points for them from the investigation

Photo explaining how it

should be done right
Strap line – should be the key (keep short and
memorable )

18
 Name
Main contractor of –Company
name LTI# - Date and incident date
of incident
Management self audit - CHECK List to confirm Yes/No
1 Do you report and investigate all occupational illnesses and NADs?
2 Are all your staff up to date with their periodic medical check and/or fitness to work?
Are all PDO specific fitness to work medical examinations conducted by PDO approved clinics?
3
and do your medical staff review the submitted reports to confirm conformance to PDO standards?
Are all employees with chronic medical conditions such as diabetes, high Blood Pressure etc being
4
followed up appropriately?
Do you conduct regular health awareness to your staff? And specifically do you encourage your staff to
5
seek medical help if feeling unwell?
6 Do your medical staff get approved by PDO medical department prior to deployment to PDO sites?
Does your medical staff attend regular continuous medical education and have valid MOH license and
7
ACLS certification?
Do you ensure calibration of Medical equipments including AED and carry out daily ambulance
8
inspection ?
Do you have Medical Emergency Response (MER) plan and do you conduct medical drills?
9
Do you have a clear Alcohol and drugs policy?
10
Does your medical service submit to PDO the monthly health performance report?
11
Is health management within the direct working environment of the deceased meeting Company
12 standards?
Are health activities included into the annual HSE plans?
13

Confidential - Not to be shared

outside of PDO/PDO contractors 19
 Name of Company and incident date
Main contractor name – LTI# - Date of incident

Sequence of events, during and post incident response – Timeline

No. Date Time Description of event

20
 Main contractor name – LTI# - Date of incident
Investigation Team Members- Names, reference indicators, role in investigation

Name Ref. Ind Role Attended HII* Date attended

the scene trained HII training
Yes / No Yes / No
1 Investigation Team Lead
2
3
4
5
6
7
8
9
10

*HII – HSE Incident Investigation

21