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 ACCIDENT / INCIDENT REPORTING:

  

    When an accident happens you should report it immediately to the supervisor or foreman. So that they have to send the report which position you are in and let the manager know what to do next. Never do any thing unless you have instruction from the safety doctor.

  •         Accident reports should be rued.

  •         Analysis of the accident should be done.

  •         Accident investigations should be carried out immediately.

ANALYSIS OF THE ACCIDENT

CAUSES OF THE ACCIDENT

-What were the causes of the accident?
  •         ·PEOPLE? …………………………………………

  •         ·WHO? ………………………………………………

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  •         ·EQUIPMENT? ……………………………………

  •         ·WHICH?……………………………………………

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  •         ·OTHERS?………………………………………………………

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PRECENTAIVE ACTIOM

  •  ·What precaution had you taken to avoid s such accidents?

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SUGESTIONS

  •         ·What suggestions can you give to prevent such accidents in the future?

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IMPORTANT

                      ·The accident file is now computerized; please fill this report very carefully.

                      ·Forward this report to the safety department as soon as possible along with an additional note or sketch if necessary.

PARTY MANAGER

SUPERVISOR

Date:…………………………………………….

Signature: ……………………………………

Date:………………………………………

Signature:………………………………

 

Note: This report can only be used for damages incidents less than $ 1000 or near misses that had potential to cause a minor first aid injury.

Type of incident:

                                                                                                         

Near miss                   Damage          Canadian Nexen        Contractor

potential of incident:

 

                                                                                             

Personal injury           Property                 Business              Equipment

     Injury                       Damage            Interruption                Damage

Damage cost:

Date:…………………………………….. Time :……………………………………..

Location :………………………………………………………………………………..

Incident Description:

:…………………………………….. …………………………………….. ……………………………………..

 

 

 

 

Reported by: :…………………………………….. …………………….………………….. ……………

 Investigated by: :…………………………………….. Position……………………………………

FOLLOW UP ACTION I INVESTIGATION.

Investigation Report filed:

       yes                              No

NOTE: if yes. this incident shall be entered on lotus notes.

       Substandard:

Action: :…………………………………….. …………………………………….. ……………………………………..

 

 

 

        

Standard Condition: :…………………………………….. …………………………………………………

Immediate Action

Taken: :…………………………………….. …………………………………….. ……………………………………..

 

 

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Corrective Action : …………………………………….. ………………………………………………….. …

 

 

 

Further Action Required:

       Yes                   No

EH & S : ………………….. …………………………………….. Date:………….. ………………

 

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