GU-612 - Guidelines - Incident Investigation and Reporting

Petroleum Development Oman L.L.C.
RESTRICTED
Jul-15
Document ID: GU-612

Filing Key: Business Control
[Health Safety Environment & SD]

Incident Investigation, Analysis and
Reporting
Guideline
User Note:
A controlled copy of the current version of this document is on PDO's EDMS. Before making
reference to this document, it is the user's responsibility to ensure that any hard copy, or
electronic copy, is current. For assistance, contact the Document Custodian or the Document
Controller.
Users are encouraged to participate in the ongoing improvement of this document by providing
constructive feedback.
Please familiarise yourself with the
Document Security Classification Definitions
They also apply to this Document!
HSE PROCEDURE
Embedding HSE into our Business
This page was intentionally left blank
HSE PROCEDURE
Document Authorisation
Authorised For Issue

Document Authority
Document Custodian
Document Controller
(CFDH)
NAAMAN NAAMANY
NIVEDITA RAM
NIVEDITA RAM
MSEM
MSE5
MSE5
Date: 30/08/2008
Date: 30/08/2008
Date: 30/08/2008
HSE PROCEDURE
ii Revision History
Authorised for Issue by the HSE IC
Document Authority
Document Custodian
Document Author
Naaman Namany
Nivedita Ram
Nivedita Ram
Ref. Ind::MSEM
Ref. Ind::MSE/5
Ref. Ind: MSE/5
Date: 30/08/2008
Date: 30/08/2008
Date: 30/08/2008
The following is a brief summary of the seven most recent revisions to this document. Details of all revisions prior to
these are held on file by the Document Custodian.
Version No.
Date
Author
Scope / Remarks
Version2.0
August 08
Nivedita Ram
Updated in line with the Yellow Guide issue Dec

31, 2007. Inclusion of Incident Investigation
Guidelines, ToR for MDIRC, OSHA Guidelines. The
Guideline replaces the PR1418 Part II and Part III
MSE5
Version 1.0
Dec-03
Ohimai Aikhoje
MSEM/4
Updated in line with new SIEP Standard for Health,

Safety and Environmental Management Systems
Incident reporting and Follow up EP 2005-0100-29.
Follows new EP global procedure for Incident Reporting
and Follow Up.
Version 1.0
July-03
Andrew Ure
Update Procedure to bring it into line with FIM Incident

Management tool, and with PDO re-organisation
(Version Not Issued)
MSEM/4X
Version 1.0
July-02
Chidozie Nzeukwu
MSEM/13
Supersedes HSE/97/01, Rev.3. Ratification of

reportable incidents by Area HSE Team Leader initially
instead of MSEM; update Environmental Incident
Notification Form; include MDC review of contractor
disqualification for fatal incidents per Commercial
Procedures and Guidelines; add MD Review of
Incidents meeting; clarify procedures relating to nonaccidental death; align risk matrix with CP 122 HSE
Management System Manual. Inclusion of information
on PDOs incident tracking tool. Inclusion of Guidelines
on operation of IRCs.(Version Not Issued)
HSE/97/01,
Rev.3
Apr-98
John
MSEM/5
Sherban, Aligned with asset Management organisation
HSE/97/01,
Rev.2
Feb-98
John
MSEM/5
Sherban, Second printing with revisions
HSE/97/01,
Rev.1
Jun-97
John
MSEM/5
Sherban, Supersedes SRD/P/01, Rev.2. Reflects changes in

PDOs organisation structure and HSE-MS.
HSE PROCEDURE
iii Related Business Processes

Code
Business Process (EPBM 4.0)
iv Related Corporate Management Frame Work (CMF) Documents

The related CMF Documents can be retrieved from the Corporate Business Control Documentation Register
TAXI.
Contents
HSE PROCEDURE
Document Authorisation............................................................................................................................... 3
ii
Revision History........................................................................................................................................... 4
iii
Related Business Processes........................................................................................................................ 5
iv
Related Corporate Management Frame Work (CMF) Documents...............................................................5
1.......................................................................................................................................................................... 7
1.
Incident Investigation & Analysis............................................................................................................ 9

1.1
Introduction.......................................................................................................................................... 9
1.2
The Initial Investigation (immediate).................................................................................................. 9
1.3
The Full Investigation........................................................................................................................ 10
1.4
Incident Reports................................................................................................................................. 20
1.5
Implementation of Recommendations............................................................................................. 20
2:
Ownership of Incidents...................................................................................................................... 20
3:
Organization and ToR for PDO Incident Review Committees........................................................24

3.1
MD Incident Review Panel (MDIR)................................................................................................... 24
3.2
Directorate Incident Review Committees (IRCs).............................................................................26
4:
Definitions and Explanation of Terms.............................................................................................. 28
5:
INCIDENT REPORT TEMPLATES...................................................................................................... 36

Appendix 1:
High Potential Incident Reports......................................................................................36
Appendix 2:
Non-accidental Death Reports......................................................................................... 38
Appendix 3:
General Medium Potential Incident Report....................................................................39
Appendix 4:
Medium Potential Road Traffic Accident Report............................................................48
Appendix 5:
List of Activity at time of Incident....................................................................................59
Appendix 6:
Definitions of Incident Types........................................................................................... 61
Appendix 7:
List of Immediate Causes................................................................................................. 62
Appendix 8:
List of Underlying Causes................................................................................................ 63
Appendix 9:
List of Facilities / Plant / Equipment..............................................................................64
Appendix 10:
List of Injury / Occupational Illness................................................................................65
Appendix 11:
Examples Determining Environmental Incident Risk Potential..................................68
1.
Incident Investigation & Analysis
1.1
Introduction
The purpose of conducting an Incident investigation and producing a formal report on
the findings is:
To identify the direct, contributing and root cause(s) of an Incident

To prescribe and implement suitable actions to prevent recurrence of a similar Incident
To ensure that legal, PDO's and shareholder requirements on injury and Incident reporting
are met
To protect against future unsubstantiated claims.
The Incident investigation, reporting and follow-up process comprises a number of consecutive
stages once the initial PDO Notification procedure has been completed. These stages are:
Initial investigation / information preservation

Formation of a full investigation team
The full investigation
Analysis of findings
Preparation, review and publication of the report (including recommendations for remedial
action)
Implementation of action items
Follow-up to ensure remedial actions are completed.
Brief guidance is provided below on how to conduct an initial and full Incident investigation and
how to complete the follow-up requirements.
1.2
The Initial Investigation (immediate)

The Responsible Supervisor/ Investigation Team Leader responsible for staff or equipment
involved in the Incident shall immediately take steps to preserve the site as it is immediately
after the Incident and if this is not possible to make notes, take photographs or draw sketches
of all relevant details.
The objectives of the initial investigation and site preservation are:
a)
b)
To ensure that the site is made safe and that action has been taken to identify the
most obvious cause(s) of the Incident and protect against recurrence.
To collect and preserve initial information prior to the site being disturbed. This will
normally include:
Identification of witnesses,
Documentation/procedures in operation at the time of the Incident,
Phase of operations, process condition, etc.,
Markings left by equipment involved,
Position of personnel and equipment,
Documentation of Emergency Response procedures immediately following the
Incident,
Time of day,
Prevalent weather conditions.
Every opportunity should be taken to obtain photographs, statements, etc. during the initial
investigation. Documentation such as 'Permits to Work' should also be collected and passed
to the Investigation Team Leader.
Prior Planning includes the inclusion of the following
a) First Aid Kit
b) Camera
c) Journey plan
Petroleum Development Oman LLC
Revision: 2
Effective: Sept 08
d) Fuel
e) Accommodation
f) Water
g) Charger
1.3
The Full Investigation
1.3.1
Determination of Investigation Level and Team Composition

Following the initial investigation, by the Responsible Supervisor, the full investigation team
shall be formed. The level of investigation, reporting and team composition required for a
given Incident is determined by the Potential Risk of the Incident. The Incident owner is
encouraged to lead the investigation in order to demonstrate an appropriate degree of
commitment.
Suggested team composition for each level of risk is included in the following table.
Additionally, if specific expertise is required to adequately determine the root causes leading to
the Incident, the Investigation team leader should contact the relevant Corporate (or Unit)
Functional Discipline Head to participate, as advisers, in the investigation and analysis. For
example, in transport and materials handling related Incidents, advice should be sought from
the Corporate Functional Discipline Head for Transport TLM or MSEM/1 and for Health
related Incidents, advice from MCC should be requested. Other assistance is also available
from outside of PDO through various contractor organisations with experience in various types
of Incident investigation. MSE department can assist in identifying suitable contractors if
required.
Table 3 - Investigation Team Suggested Make-up

Potential Risk Classification
Suggested Minimum Investigation Team
Low
Section Head, PDO Responsible Supervisor,

Contractor Representative
Medium
Department Head or Area Team Leader, Contract

Holder, Contract Manager, Area HSE Adviser
High
Director, Department Manager, Contractor CEO /

Director, HSE Team Leader
These are suggested minimum team compositions. It is entirely up to the Incident owner to
assign his investigation team based on the expertise of his personnel. The Incident owner is
accountable to his Director and the Managing Director for the quality of his investigation and
report. Normally a joint investigation conducted with any involved contractor is preferred;
however, should a Contractor wish to conduct a separate investigation according to its own
procedures and processes, then it is free to do so. In this case, it is strongly recommended that
the Incident Review Committee reviews the Contractors' associated Incident report at the same
time of the review of PDO's Incident review.
1.3.2
Investigation Timing
Investigations should take place as soon as possible after the Incident has occurred. The
quality of evidence can deteriorate rapidly with time, and delayed investigations are never as
conclusive as those performed soon after the event. Important evidence can be gained from
observations made at the location, particularly if equipment remains as it was immediately after
the Incident. In the case of fatal Incidents and Road Traffic Accidents, the scene must not be
disturbed until permission is obtained from local ROP Senior Officers.
In this case the scene and all evidence should be preserved to prevent deterioration as much
as possible.
1.3.3
Background information
Page 8
Incident Investigation, Analysis and Reporting Guideline
Printed 17/08/08
The controlled version of this CMF Document resides online in Livelink. Printed copies are UNCONTROLLED.
Revision: 2
Effective: Sept 08
Background is required on the following for most Incidents:

General Procedures and Standards for the type of activity/operation being carried out at
the time. These may include departmental instructions, safety regulations, written
instructions, permit to work, policies and contract scope of work.
Location plans and road maps etc.

Organisation charts showing local command structures and listing persons involved.
Responsibilities, experience and training of personnel involved.
Contingency plans / emergency response procedures.
Hazard management controls which should be in place according to the provisions of
the Contract HSE Plan, applicable Safety Case(s), Hazard Control Sheets and Job
Safety Plans.
1.3.4 The Investigation Process

General
In general the investigating team should consider the following points:
1. Confirmation of the potential severity and probability of the Incident happening again ( i.e. risk
to PDO )
2. The need to establish as many facts as possible to properly understand the events surrounding
the Incident and, to establish the sequence of events.
3. Where information is absolute fact this must be stated with supporting evidence. If any
information is the result of supposition or a reasoned assumption then this must also be made
clear.
4. The need to address the question of 'WHY' an act or condition was not recognised, or was
recognised and tolerated. Keep asking 'why' until no more fundamental reasons or causes can
be found. Try to establish not only the immediate causes, but also the underlying and root
causes.
Immediate actions at the incident site:
Ensure the scene is safe for you to enter
The injured person needs looking after
Secure the incident scene
Isolate all machinery/equipment, make notes of status
Identify and preserve all physical evidence
Record details of the scene, photographs/video/sketches
Identify all possible witnesses
A structured checklist, in the form of a guide has been developed from various sources to help maintain
the required breadth of inquiry. The scope of the investigation is divided into four areas:
Prevailing Environment
People
Organisation
Equipment
In each section a number of basic questions cover the general scope of the investigation, while the
follow-on questions should be addressed where faults or unsafe conditions are found. The follow-on
questions in some cases lead to one of the other general areas. The guide may also assist in
identification and classification of causal factors for recording and analysis purposes.
There are at least eleven core areas of investigation:
1. The Injured person (IP)
Page 9
Printed 17/08/08
You have to find out as

much as possible about
the injured person to be
able to see the incident
from his point of view. You
have to be able to get
inside his head at the time
of the incident to be able to
understand it.
One of the problems you
may encounter is the IP is
not immediately available,
this results in you
conducting the
investigation and drawing
conclusions prior to getting
his version of events.
Beware, the IP interview
may put a whole new twist
on events
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
Revision: 2
Effective: Sept 08
Name, age, service with the company

Medical condition and medical results
Experience in role doing at time of injury
What was he employed to do?
What activity was he doing when injured?
Was he authorised to do the activity?
Was he competent in conducting the activity?
Is there evidence of competency through training or instruction
in the job?
How many hours had he worked that day?
How many hours had he worked that week?
Had he reported feeling sick or poorly?
Was he happy about doing the activity?
How many hours had he driven?
How many hours did he have to go in the journey?
Had he complained of problems relating to the activity or
equipment prior to the injury being sustained?
What motivators were there for the employee to potentially
break rules?
What is his character like?
What is his previous incident record like?
What is his training attitude like?
What is his attitude to rule breaking like and diligence?
Had he just changed roles recently?
Has he been doing the same job for many years?
What did he do before being employed by you?
Had he been inducted in health and safety and when?
What is the content and make up of the training received?
Can the company confirm through evidence the content of the
training and instruction?
Can the company confirm through evidence the competency of
the trainer or instructor?
Did the employee confirm he understood through testing?
2. The Equipment:
Page 10
The equipment is
often immediately
blamed for the
cause of the
incident.. The
equipment was
faulty. the brakes
failed.. the
steering jammed
It is therefore
essential to evaluate
the equipments part
in any causation of
the incident itself
1.
Record the serial numbers/number plates of all of the

equipment involved in the incident to avoid confusion
2.
Was the equipment the correct equipment for the task?
3.
Visually check and record the state of the equipment at
the scene
4.
Record all such defects as found and make a
judgement whether they occurred as a result of the incident or
not Test and inspect the equipment to ensure it was in a good
state of repair. Do so with someone who knows about the
equipment as soon after the incident as possible
5.
Was the equipment being used in the correct manner?
6.
Review the servicing and maintenance records for the
equipment
7.
Review whether pre-shift checks had been conducted
for the equipment, the results and any follow up
8.
Identify the history of the equipment in relation to
defects, complaints or previous incidents it was involved in.
9.
Check if a cause of the incident was due to equipment
not being used when it should have been
10.
Check where equipment had not been used as required,
Printed 17/08/08
Revision: 2
Effective: Sept 08
that it was available to the employee

If not available then check if employee raised it as an
issue and if so what happened as a result
Was any PPE needed to use the equipment
Was the correct PPE being worn correctly
Identify if the correct PPE had been issued
What was the condition of the PPE
11.
12.
13.
14.
15.
3. The Environment
The environment can have

a significant influence on
the causation of an
incident. There are two
types of environment
Static environment
building layouts, road
layouts, structures
Dynamic environment
state of floors, road
surfaces, spills, skid
marks, lighting, heating,
weather, animals,
personnel, traffic etc
Static Environment
1.
2.
Will change very little over time.

The investigation will need to record:
- The workplace or road layout
- Signage, road or walkway markings
- Distances, to-from junctions, between machinery
- Ambient conditions; machinery noise etc
- Topography of surrounding area
- Anything else nearby which may have a bearing
on the incident; childrens play area etc
Dynamic Environment
1. Dynamic environmental conditions are lost immediately after
the incident. It is therefore of utmost importance to capture as
much information on the immediate environment as quickly
as possible.
2. For example in an RTA investigation traffic flows may be
completely different at different times of day or even on
different days.
The investigation will need to record:
1.
2.
3.
4.
5.
6.
Weather and lighting conditions at the time of the incident

Positions of related objects, bodies, debris
Positions of controls, status of equipments
Skid marks, spills, (or puddles),
Dust conditions
Ground conditions & the state of it
4. The Third Parties

Third parties are the other
persons who were involved in the
incident except the injured
employee
Third parties are difficult to involve in our investigations as

they either
1.
2.
3.
4.
5.
6.
7.
Are dead
Are injured and in hospital
Have left the scene before our attendance
Are upset and do not want to talk about it
Are uncooperative as they do not want to incriminate
themselves
Can not communicate in English
Embellish the truth to their own ends and means
In dealing with third parties remember:

1. We have no legal jurisdiction over them and can not force
them to provide information
2. They may be in shock and so do not hassle them
Page 11
Printed 17/08/08
Revision: 2
Effective: Sept 08
3. Liaise with the ROP as much as possible to ascertain what

they have managed to discover
4. Any information they give you is to be treated as hear-say
5. Remember the cultural differences which may be involved
5. The Other Parties
The incident could have

been witnessed by other
persons not directly
involved in the incident
They can be useful to allow
you to build up a mental
picture of what has
occurred and information
can be collected informally
When collecting evidence from other parties be aware:

1.
They may not be impartial to the persons involved in the

incident (rig move staff, well engineers etc)
2. They may embellish what they have seen to make it more
exciting, (who wants to relay a boring story)
3. What they think they saw may not in reality be true as it is
their perceptions they are relaying to you
4. Collecting perceptions from a number of different witnesses
allows you to make an informed judgement of the event
5. You have no rights or jurisdiction on that person
6. They are volunteering information attempting to formalise it
may make them withdraw
7. Chat with them, ask questions, be interested
8. Dont start making notes, write it down later
9. Distinguish facts from opinions
10. If using an interpreter, ask short questions, wait for the
answers
11. Dont argue with them, if you or they are unclear act
confused by the point, they may fill it in for you
6. The activity taking place at the time

The incident will
always involve an
event taking place at
the specific time the
injury or damage
was caused
It is often very easy
to identify the event
which was taking
place, it is more
difficult to analyse
the event and
identify whether or
not it was the correct
event or was being
done correctly
When identifying the activity determine the following

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Page 12
Was the activity part of the normal task conducted?

Would the activity appear to have been done correctly?
Is the activity difficult or complex?
Is the activity itself risky or dangerous?
Has the activity itself been documented and risk assessed?
Is there evidence of shortcuts been taken?
Is it an activity which is open to shortcuts?
Is the activity commonly conducted or a rare event?
Is the activity an every day occurrence in the field by other
persons?
If so, can other persons comment on the shortcuts or problems in
conducting the activity?
Are there any particular circumstances which might have led to the
activity been done differently this time?
Is the activity a relatively new activity or new equipment or has it
taken place for many years?
What are the controls which should be in place as a result of the
risk assessment?
Is there evidence that these controls were or were not in place?
Are the controls which are in place adequate for the level of risk
posed by the activity?
Printed 17/08/08
Revision: 2
Effective: Sept 08
7. The activity taking place before hand

Sometimes the activity taking
place before the event is as
crucial as the event itself
The activities prior to the event
and even the day before enable
you to understand more about
the frame of mind of the injured
person, his potential
motivations and what led him to
do what he did (if relevant)
The length of time analysed
before the incident will depend
on the nature of the event itself
1.
2.
3.
4.
5.
6.
Ask the injured person or persons with him to talk through

the events of the shift from the start, clarify timings with
the interviewee
Ask them what they had done on the previous shift and
the time between shifts
Ask them to elaborate on anything which you feel could
be of relevance to the investigation
Cross reference what they have described, involve other
people to confirm that they have their facts correct.
Question any discrepancy between their account and that
which you know to be fact or deviations from procedures,
journey plans or other accounts.
Do not make them feel they are being cross examined,
they will dry up.
8. Historical information
Sometimes during
the investigation or
interview you may
find that this is not
the first incident of
this kind. Reviewing
the findings of the
previous
investigation can
add value to yours.
Do not though
assume the
causation is
precisely the same
by default.
It may also be that
discussions have
been ongoing
relating to a potential
problem. If you can,
review any minutes
etc from these
discussions.
1.
Check with management if issues relevant to the incident have been

raised before
2. Collect any evidence of such issues being raised
3. Follow the evidence trail of the issues raised in relation to who were
involved, how they were involved, what actions were taken, what
actions were not taken
4. Identify if, where actions were not taken, could they have prevented
this specific incident if they had been
Check
1. Minutes of meetings
2. STOP cards
3. Near miss reports
4. Emails
5. Letters and memos
6. Complaints made or escalated
7. Ask people if the risk had been raised historically
Important note
Only raise issues in the report if they are directly linked to the causation of
the particular incident you are investigating. Do not increase the scope of
the investigation to other failures which are not relevant, they should be
dealt with separately
Records and Procedures
1.
2.
3.
4.
5.
Records such as 'as built' drawings, instrument records,

computer printouts, log books, transport documentation and time
sheets
Previous Audits and Incident investigation reports
What procedures exist for tasks being performed at the time
of the Incident
Instructions and Procedures such as Permit to Work
If a Procedure was not followed, try to establish why it was not
followed: was it not known; not fit for purpose or, was there some other
reason
9. The hazard and risk equation leading to Root Cause Analysis

Page 13
Printed 17/08/08
A risk assessment identifies the

potential for an incident to occur.
It identifies the hazard,
something which has the ability to
cause harm.
The risk is simply the likelihood
that the harm will be released
An incident means the harm has
actually been released
Identify where a particular
condition was over-riding in its
impact or whether a combination
of several conditions combined
led to the hazardous situation
arising.
Use the domino principle
Unsafe act by individual, competency,

training and instruction, standards of
supervision, management philosophy
poor planning or design, deficient
management policy, expenditure or high
level decisions
Revision: 2
Effective: Sept 08
1. Work back from the known point of injury and identify the
actual hazard which led to the injury or the damage being
caused.
2. Identify the primary conditions which led to the circumstances
where the person could be harmed etc
3. Identify the secondary conditions which led to the
circumstances creating the primary conditions
4. Continue repeating this until such time as you hit the core
conditions which enabled the chain of events to start
5. Note that several primary or secondary conditions can result
which all need investigating and resolving as separate paths
6. For each condition or circumstance which contributed to the
incident identify the combination of controls which could have
been in place to prevent it arising
7. Identify if there was custom and practice where the official
controls are ignored habitually
8. Now identify the different manner in which the controls which
could have been in place can potentially fail and thus be
nullified
9. Record the conditions, circumstances, possible controls and
potential failures of such controls
10. Use the 5 Whys to try and find the answers and to keep
digging down until you discover a root cause
10. Witness Statements

Witness statements
can be vital in
determining the
outcome of the
investigation.
Remember you are
not interrogating the
witness, you are trying
to solicit information
which will help you to
piece together the
chain of events.
They must be
conducted in a timely
and professional
manner.
Try and collect statements in the following order:

a) Injured person
b) Witnesses
c) Line management
1. If the injured person is unable to be interviewed gather as much
evidence as possible from witnesses.
2. If unable to interview the injured person ask him to write down
whatever he remembers of the incident for you to review later.
3. Prepare for the interview, ensure you have privacy and any
equipment/information you may need beforehand.
4. If the witness wishes to have someone present allow it but do not
allow them to answer questions for the witness unless translating.
Identify the witness, make sure you have names, contact details
etc correct.
6. Put them at ease, ask how they are feeling etc, explain the purpose
of the investigation, (incident prevention) to them and introduce
yourself, even if you know them.
7. Use a chart or sketch of the incident scene if necessary to locate
the positions of all witnesses.
LISTEN to the witnesses, allow them to speak freely, be courteous and
considerate. Let them put forward their version of events.
1. Try not to stop the flow, if you are unsure or the witness goes off
track try to bring them back gently by asking them to explain a
point in more detail.
2. Take notes and type the interview up as soon as possible,
Page 14
Printed 17/08/08
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Revision: 2
Effective: Sept 08
certainly before the next interview as you will not remember who
said what later. Provide a copy to the witness if requested.
Word each question carefully and be sure the witness
understands. Use a combination of open and questions.
Open to elicit information; what did you see?
Closed to clarify a point; did you see the truck?
Be sure to distinguish facts from opinions
Be sincere and do not argue with the witness.
Use the interview to attempt to clarify any points you are unsure
of.
Not all people will react the same to a particular stimulus, a
witness close to the event may have a completely different
version to someone who saw it from a distance.
Stories may change with time and contact with other witnesses.
A traumatized witness may not be able to recall all the events
Witnesses may omit entire sequences for various reasons such as
failure to realize their relevance, failure to observe, personal
reasons, bias etc.
11. Chain of events

In any investigation it is always important to
ensure that the evidence which you have
gathered as part of the investigation can be
relayed back to the actual incident.
All photos need to be date stamped and
named and signed on the back by the
person who took the photographs. Number
each photo so they can be refered to in
meetings by its reference number
Any notes or sketches which are made as
part of the investigation should be kept in
the investigation file and marked as working
papers. Each page should be individually
labelled, for instance WP1 or WP2 etc.
This is important as you may need this to
clarify a statement you have made in the
investigation report
Ensure all documents which you have
collated as part of the investigation are also
labelled for example E1,E2, E3 and then
ensure that you label how many pages each
document contains, e.g. page 1 of 2, page 2
of 2.
Keep all of your relevant documents
together and order them in an investigation
file so that they can be catalogued and
create an index.
Create the investigation report in the
required format calling on information which
should be readily available from the
investigation file.
1. Ensure an investigation file is created which

has all of the supporting documentation from
the investigation
2. Hazard and effects
3. Working papers
4. Risk assessments
5. Inspection records
6. Procedures
7. Previous incidents
8. Training records
9. Maintenance records
10.Employee records
11. Photos and sketches
12.Witness statements
13.Guidance documents
14.Health records
15.Pre-shift check records
16.Minutes of safety meetings
17.Previous complaints
18.Pass the file to HSE Dept on completion of the
investigation.
Incident reporting
Do not be ruled by the form ask other questions continually throughout the investigation.
Keep the purpose of the investigation in mind at all times, (prevention of re-occurrence).
Do not fall into the trap of immediately blaming the IP/employee and suggesting remedial training.
Page 15
Printed 17/08/08
Revision: 2
Effective: Sept 08
The objective of the low potential form is to carry out a simple investigation and provide meaningful
corrective actions asap, as mentioned the form may be re-submitted if root causes cannot be
immediately established.
Medium and high potential incidents require a more in-depth investigation.
Use the template provided for a full report, this will be going on the website in the next few weeks.
PDO require a Tripod beta analysis for all high potential and fatal reports. They will do it.
You will be being investigated by the ROP as well as investigating internally in most fatalities.
The construction of a diagram showing the connections between the various events and conditions
leading up to the Incident - an Incident tree - has proved to be an essential tool in determining the
underlying causes and conditions leading to an Incident.
For High Potential Incident & fatality investigations, a process known as Tripod Beta should be
used to develop an Incident causation tree. Unit or Corporate HSE Advisers should be approached
to assist in this. Tripod Beta uses a specific logic methodology which is extremely powerful in
determining root causes of Incidents.
Preserving Physical Evidence
In some Incidents components or equipment may be damaged or have failed. In these cases, the
equipment should be lodged in a secure place pending more detailed analysis.
Conducting Interviews with Witnesses and Supervisors
Conducting Special Studies
Incidents of an involved or complex nature can require the analysis by specialists to determine
causes of failure. Aircraft crashes, crane failures and explosions are examples of such Incidents.
This should rapidly be identified and the specialists be involved early in the site assessment.
Requests should be made to the appropriate Corporate Functional Discipline Head(s) to assist in the
provision of such specialist support as required. The investigation team should ask whether the
ROP or the relevant medical officer have conducted any tests to determine if alcohol or drugs may
have contributed to the Incident.
'Rules of Evidence'
The investigation team leader must avoid the presentation of supposition as though it were fact.
Whilst it may be appropriate, sometimes even necessary, to evaluate the most likely cause(s) of an
Incident on the balance of probability, it must be avoided where the implication is that somebody
specific was responsible for the Incident. In such situations, the investigation must limit itself to the
facts. This is especially important if there is any possibility that criminal proceedings may result.
Supposition or assumption should be clearly stated as such and not confused with fact. Remember
that the main purpose of Incident investigation is not to assign blame to individuals.
Underlying causes and human factors
The initial stages in an investigation normally focus on conditions and activities close to the Incident
and only Immediate Causes may be identified at this time. However, the conditions underlying
these causes will themselves need to be investigated. As the extent of above physical factors
surrounding an Incident become clear, the investigator(s) should shift the emphasis of their
investigation and questioning to the underlying causes and to the reasons for peoples' actions. This
will allow for ease of assessment when analysing the Incident. It may be necessary to take a closer
look in the following areas:
Page 16
Engineering design
Operating procedures and philosophies
Equipment selection
Planning methods
Job responsibilities and descriptions
Discharge of HSE responsibilities
Organisational relationships
HSE systems and Control systems
Printed 17/08/08
Revision: 2
Effective: Sept 08
Training methods and experience criteria

Working/duty hours policies and practice
Internal safety inspections/auditing
Contract conditions and control
Maintenance procedures and records
Testing methods and records
Communication and availability of information
Abuse of alcohol or drugs
It should be noted that an investigation confined to immediate surroundings of the Incident will only
be able to identify localised causes. Recommendations will therefore, only be able to deal with local
problems and will not be effective in preventing similar Incidents elsewhere or involving other
groups of workers carrying out different but related tasks. In all cases, systematic investigation
should ensure that possible causes are considered both in the
range and depth appropriate to the Incident.
Analysis of findings and drawing conclusions
The purpose of the analysis stage is to identify critical sequences of events and to draw conclusions
with respect to immediate and underlying causes.
Data may be in the form of:
Hard evidence: data which usually is not disputed such as written records, evidence of
physical conditions, photographs of the undisturbed site, tests for alcohol or drugs etc.
Witness statements from people present at the time of the Incident and immediately
afterwards.
Reports of tests carried out since the Incident.
Circumstantial evidence: the logical interpretation of facts that leads to a single, but
unproven conclusion.
Identification of recommendations
The final list of recommendations for action should include AT LEAST ONE action against each
identifiable cause. It should be noted that not all causes can necessarily be eliminated, and some
may only be removed at prohibitive cost. Some recommendations will therefore aim at reducing a
hazard to a minimum, practicable level, others at improving protective systems to limit the
consequences.
Recommendations should be SMART : Specific; Measurable to the extent that it is clear when they
have been implemented; Achievable, Relevant to an identified cause (immediate or underlying) and
have a Target completion date assigned. Statements such as the following are expressions that DO
NOT satisfy these requirements!
'Drivers should take more care......
'Supervisors should ensure that
'The rules for..... should be followed.'
'More attention should be given to......
Recommendations should be structured corresponding to the failed barriers. Description of actions
should be worded in such a way as to clearly indicate how the Incident follow-up coordinator will
know when the action is complete.
The wording and target due dates for each action shall be agreed with each assigned action party
before the report is submitted to the relevant review committee. If agreement can not be reached
then this difference in opinion must be highlighted to the appropriate review committee who shall
decide if the recommended action is valid or not.
Page 17
Printed 17/08/08
Revision: 2
Effective: Sept 08
Recommendations should generally be restricted to the key issues which contributed to the Incident
being investigated. They should address actions which are necessary to ensure that failed or
missing controls or barriers, which would have prevented the Incident and/or reduced the
consequence, are in place in the future. The reason for this is to sharpen the focus on the specific
learning points from the Incident. If other areas for improvement, which did not have a significant
impact on the specific Incident, become apparent during the investigation process, then these
should be communicated to the relevant person for action outside of the Investigation report
as part of PDO's normal business process.
1.4
Incident Reports
The degree of reporting required in the event of an Incident is determined by the potential severity
of the Incident and the probability of a similar Incident re-occurring. Refer to the Incident HSE Risk
Matrix
Reporting of Low Potential Incidents, is limited to a completely and accurately filled out
Notification form - either a Health and Safety Incident form or an Environmental Incident form.
All other Incidents require a more formal Incident Report in addition to the Notification. Two
different types of Incident Report exist for Medium Potential Incidents - one for each of the
following types of Incident:
Guidance on completion and routing of general Incident Reports is also provided in Appendix 3
A more comprehensive and detailed report is required in the event of a High Potential Incident. A
template for such a report is also provided in Appendix 1.
A simplified report is required in the case of a non-accidental sudden death of a person employed
by or on contract to PDO. A template for this special report is also included in Appendix 2.PDO's
medical department can assist in the completion of this report.
1.5
Implementation of Recommendations
Implementation of action items must be formalized for effective follow-up. All actions must be
tracked through FIM. In addition, it is necessary to inspect/audit at periodic intervals to ensure that
improvements have been sustained.
2:
Ownership of Incidents
Incident ownership is a term used to designate PDO single point responsibility for ensuring that an
Incident is investigated, reported and followed-up according to the requirements set out in this
document. Ownership is first assigned to a PDO Responsible Supervisor and then delegated to the
appropriate level within that Line for action. The organisation Line in this respect refers to PDO's
reporting Line from MD to Director to Line Manager to Department Head to Section Head, etc.
Within any given organisation Line, certain individuals are designated as Asset Managers, Contract
Holders, Site Representatives, etc. in line with the Asset Management or Contract Holdership
responsibilities.
There are two types of Asset Managers Product Flow Asset Manager and Service Provider Asset
Manager. There are also Process Owners e.g. UEOD for Engineering and Operations Processes, Risk
Advisors/Managers e.g. MSEM for HSE Risk and Skills Pool Managers (CFDHs). Each Manager is
directly accountable to the MD for the performance and development of his/her asset including staff
resources, however various assets are organisationally grouped together under a Director who is
responsible for the group of Assets under his/her control.
From time to time, depending on the activity, an Asset Manager (AM), such as a product flow AM,
may grant authority over a defined portion of his assets to another AM, such as a Service Provider
Page 18
Printed 17/08/08
Revision: 2
Effective: Sept 08
who then becomes an Asset Custodian. The Asset Custodian then assumes full responsibility, on
behalf of the Asset Manager, for all activities and assets within that defined area.
The Service Provider AMs provide common services to support primarily the product flow Asset
Managers. These services include drilling, logistics, seismic, finance, telecommunications, etc. Some
of these Service Provider departments are organised within the same Directorate, or Line, as the
Asset Managers and others are organised into separate Lines such as the Drilling Engineering and
Exploration departments.
All Incidents are required to be investigated and reported, according to this document, ultimately to
MD who in turn is required to report elements of PDO's corporate performance to PDO's shareholders
according to separately agreed requirements. The designation of Incident ownership within PDO is
therefore a structural means by which PDO may systematically investigate, report and follow-up any
HSE Incidents which occur in the course of running the business. The ultimate aim is to manage
PDO's activities in line with the corporate policies.
Line Incident ownership is determined according to the following criteria which are aligned with PDO's
structure of Asset Managers and Service Providers. Incident ownership should normally rest with
the reporting Line which has most influence over the site or activity.
The purpose of defining clear criteria for Incident ownership is to ensure that in every event,
clear rules will always lead to positive Incident ownership immediately after the Incident so
that no time is lost in carrying out the investigation. It is understood that the criteria below
may not always be the most fair in light of the prevailing circumstances. However if the rules
are applied consistently and immediately, the benefit will outweigh any harm.
a) If the Incident, excluding transport related Incidents, occurred within one of the
following Asset Manager areas of operation, then ownership rests with the reporting Line of that
designated Asset Manager: any interior operational facility, installation or Operations asset such as:
-
plants, pumping & compression stations,
well sites,
PDO & Contractor interior offices, camps, workshops & recreational facilities,
flowline or pipeline rights of way, etc.
any area of common use within the physically fenced coastal office and industrial
area
b) If the Incident, excluding transport related Incidents, occurred within an area where holdership
was temporarily transferred, in a written agreement, to an Asset Custodian, then ownership rests
with the reporting Line of that Asset Custodian. This would normally apply to any:
-
drilling and service rig locations and associated camp sites,
seismic operational areas and associated camp sites,
supply warehouse and storage areas
green-field construction sites
fenced off or access controlled areas of existing facilities where only construction
or
maintenance activities are underway
-
interior contractors' facilities where only one PDO Contract Holder or Service
Provider is designated as accountable for those facilities
Page 19
PDO School and Ras al Hamra Recreation Centre

Printed 17/08/08

-
Revision: 2
Effective: Sept 08
defined areas within the Main Office complex.
c) If none of the above criteria are definitive, still for non-transport related Incidents, then Incident
ownership rests with the reporting Line responsible for supervising the activity during which the
Incident occurred. This rule shall then apply unless the involved parties have a documented
agreement in place which clearly defines alternative roles and responsibilities. Such a documented
agreement may take any form (e.g. a corporate procedure or an agreement covering the supply of
labour from one party to another) provided that it clearly states respective roles and responsibilities
and, is accepted by both parties.
It is therefore important for all parties who make such agreements to keep copies of the agreements
in case there is a dispute.
For all transport related Incidents (except milk run journeys without a single contract holder as
described in item 5 below), PDO Line ownership rests with the reporting Line of:
the person in control of each vehicle at the time of the Incident if that person is directly
employed by or seconded to PDO, or
the Contract Holder of the relevant Contract in control of each vehicle at the time of the
Incident.
If more than one PDO reporting Line is involved then Line ownership rests with the PDO reporting
Line which suffers the most severe injury, or the most damage if no injury is sustained, as a result of
the Incident. In the remote instance that all injuries and damage are equal then MSEM shall assign
Incident ownership based on his perception of which Line had most influence over the activity or site
at the time of the Incident. In the absence of MSEM, the acting MSEM shall make this decision and
this decision shall be final. In such an instance, the Incident should be investigated and reported
jointly with participants from each of the involved Lines and with the Incident Owner leading.
d)
A special procedure exists if a transport related Incident occurs during a "milk run" journey
where one journey was being used to supply or service more than one site or contract, whether for
PDO, a PDO active Contractor or a third party and where there is no single Contract Holder or
manager accountable for that journey.
For the purpose of determining Incident ownership, the
journey shall be divided into discreet sections. Each section shall have a beginning or "dispatching"
location and an end or "receiving" location. Each journey section shall progress from departure from
the dispatching location until arrival at the next receiving location. Incident ownership for each
section of such a milk run journey rests with the reporting Line of the Asset Manager or Service
Provider (as described in items 1, 2 and 3 above) which has the most influence on that section of the
milk run journey. To avoid debate on the significance of the degree of influence, for the purpose of
determining Incident ownership, dispatchers are considered to have more influence than receivers.
Therefore, Line ownership rests with the reporting Line of the dispatching location of the relevant
section of the milk run journey.
Incident ownership for the first section of such a milk run journey, from the home base to the first
receiving location, also rests with the reporting Line of the first receiving location. This also applies if
the first location is a supply warehouse or yard such as at MAF. If the Incident occurs on a section of
the journey where the last dispatching location was a third party or non-active Contractor, then for the
purpose of determining Incident ownership any third party or non-active Contractor location shall be
ignored and ownership shall flow through to the last PDO or active Contractor dispatching location.
An example of the above procedure is shown in the diagram below with the arrows showing the
journey sections and direction of travel and with the Incident owners shown in bold italics beside their
assigned sections of the journey. Where an agreement is also in place as defined in items 1, 2 or 3
Page 20
Printed 17/08/08
Revision: 2
Effective: Sept 08
above, then ownership for each section of a milk run journey would also pass to the asset custodian
or service provider who required the supplies or services to be brought to their respective locations.
Figure G1 - Milk Run Journey Incident Ownership
SERVICE RIG
MAF Supply
Yard
(SUPPLY YARD
ASSET HOLDER)
(SERVICE RIG
ASSET HOLDER)
(SUPPLY YARD
ASSET HOLDER)
HOME BASE
SEISMIC CAMP
(SEISMIC CAMP
ASSET HOLDER)
(OPERATIONS
ASSET HOLDER)
PRODUCTION STATION
3rd Party
It is important to note that this determination of Incident ownership shall not affect the well established
journey management system where the journey manager is fully responsible for planning the entire
journey wherever he is located.
e) Once Line Incident ownership is determined, the authority level within that Line at which Incident
ownership normally rests is determined on the basis of Incident potential according to the HSE Risk
Matrix reproduced in Figure G4 below. Three levels of authority exist to cover the three classes of
potential risk to the Company Director level, Department Head / Area Team Leader level and
Section Head Level.
Figure G1 - Incident Ownership Level of Authority
Potential Severity
Limit to Delegation Incident Owner
Low
Responsible Supervisor
Medium
HSE Team Leader
High (without fatality)
Manager
High (single fatality)
Director
High (multiple fatality)
MD
Although the entire generic matrix is shown for completeness, for practical purposes columns A and B
will rarely if ever be applicable for potential risk assessments. Also, a potential risk of 0 is irrelevant
and therefore row 0 shall never be used in this context. Most PDO Incidents then will fall in the range
between severities 1 to 4 and probabilities C to E.
The person identified as the normal Incident owner in Figure G1; however, has discretion to delegate
responsibility for investigation, reporting and follow-up according to his / her assessment of the merits
of the learning value for the case in question and according to the specific capabilities of his available
personnel. It must be emphasized that the Incident owner is still accountable for the quality of this
work. The limit to delegation is determined on the basis of Incident actual outcome, not potential
outcome, as follows:
Page 21
Printed 17/08/08
Revision: 2
Effective: Sept 08
Table G2 - Limits to Delegation for Investigation

Actual Severity
Limit to Delegation
0, 1 & 2
Responsible Supervisor / Section Head
Department Head
Manager
Director
Investigation and reporting of a non-accidental death may be delegated to the Section Head
level provided that there are no apparent unusual circumstances surrounding the death.
Example
A driver was rushing to return to his camp at the end of a long day. At a distance of 40 km from his
destination he rolled his vehicle over. He received a minor injury which subsequently received First
Aid treatment. He was lucky in this respect because he wasn't wearing his seat belt and had no other
passengers with him. He was found by another road user some 30 minutes after the Incident.
There is a reasonable chance that the driver could have been killed and, of a similar Incident
happening again if nothing is done to prevent it. This type of Incident happens more than five times
per year within PDO but less than five times per year in that area or with that rig. Using Figure 4, an
Incident Potential of 'D4(People)' is proposed by the Incident Owner. Upon early review of the initial
notification, the Director learns that the circumstances of the Incident closely resemble those of an
Incident six weeks earlier, for which a thorough investigation had taken place and, various
recommendations implemented. Little benefit would be gained by the Director leading the
investigation into this Incident, so he elects to delegate. Given that the actual outcome was a First
Aid Case (Severity 1), the lowest level to which the Director may delegate responsibility for leading
the investigation & follow-up, is to the Responsible Supervisor level.
3:
Organization and ToR for PDO Incident Review Committees
3.1
MD Incident Review Panel (MDIR)
3.1.1
Description
The following describes the Terms of Reference and operation of the Managing Directors Incident
Review Panel, as reiterated in PDO Management Circucular: Rev 1, dd 11/03/2007
3.1.2
Objectives
The MDIR is principally concerned with preventing the recurrence of incidents via the cascade of action
items across PDO and Contractor operations, and to act as a forum that allows MDC to hear, at first
hand, HSE views from the workforce. It also enables MDC and Contractor CEOs to assure first line
Supervisors of their support for continuous HSE improvement and to raise the importance of effective
first line supervision.
3.1.3
Participants
Table G3: MDIRC Participants
Page 22
Printed 17/08/08

Regular Attendees
PDO Attendees
invitation
3.1.4
Revision: 2
Effective: Sept 08
MD, DMD, OPAL Representative, MSEM, MSE5

by
Appropriate PDO Director, Contractor Holder, Line Supervisor,

Asset Managers
Contractor Attendees
by Invitation
Contractor MD, first line Supervisor, HSE Manager
Others by Invitation
Personnel invited by Asset Manager or Contractor MD where

appropriate
Location and Meeting Frequency
The review will take place on Monday afternoon 2 weeks of the incident happening in the Board Room,
starting at 13.15hrs and lasting up to 30 minutes per item. Before coming to the MDIRC the LTI will
have been reviewed with the responsible PDO director.
3.1.5
Preparation
The preceding Wednesday, MSE/4212 will issue the agenda and timing for the review. Relevant
Director, Line Manager, Incident Owner and Contract Holder (when applicable) will be advised.
The preceding Saturday, the Incident Owner shall issue the pre-reading material to MSE/5, who will
review and forward to the MSE/4212 for submission to MDIRC members.
3.1.6
Agenda
The Incident Owner will be the secretary for the incident during the review. He will identify those action
points with clear lateral learning value for company-wide cascade. MSE/5 will facilitate this process
and ensure the learning are cascaded appropriately.
Lessons learned from the review will be published on the HSE website and email sent to all Directors
and HSE Team Leaders. Directors and line managers will be required to cascade these lessons within
their organisation, and OPAL Representative will cascade same lessons amongst its members via copy
of the weekly highlights.
3.1.7
Review
MDIRC will review all LTIs in addition to fatal and high potential incidents.
Besides MDIRC permanent members, the appropriate PDO Director, Incident Owner, Contract Holder
and line supervisor are required to be present in the review. The Contractor MD will be invited by the
Contract Holder, where contractor staff is involved. Line Director or Contractor MD can invite other
personnel where they feel this is appropriate.
3.1.8
Meeting Format
The format of the review remains a round table, with a short presentation by Line Manager or
Contractor CEO. The presentation package shall be as per the templates provided (Medium potential
LTIs and High potential/fatalities), with the presentation taking no more than 5-10 minutes, allowing 20
minutes for discussion. Incident reports are not required to be submitted at this time, but should be
completed within 3 weeks of the review and copied to MSE/421 who will ensure the actions and report
are input into FIM.
3.2 Directorate Incident Review Committees (IRCs)
Each directorate will continue to have its own Incident Review Committee (IRC), which will
function in line with foregoing MDIRC scheme, as follows:
Page 23
Printed 17/08/08
Revision: 2
Effective: Sept 08
Each IRC will review LTIs and medium potential incidents that occur within its business area in the
preceding week. To ensure coherence, some IRCs may be set up on the basis of Work
Practitioner Groups, e.g. DOIRC, XIRC, etc.
The Director will appoint a focal-point for each IRC who will be responsible for co-ordination of the
IRC meetings and ensuring LTI Briefing Packs are prepared within 10 days of the review to
cascade lessons across the company.
LTI Briefing Packs will only be issued company-wide by MSE/43 after review to ensure quality and
consistency. MSE/43 will provide standards template for the packs.
Minutes of the IRC and action items shall be copied to MSEM and MSE/5/421.
The intention is to continue to hear views from the workforce, raise the importance of the first line
supervision and assure supervisors of MDCs and CEO's support for their HSE tasks. Victimisation
is neither allowed nor intended and the reviews will therefore be carried out in an atmosphere
devoid of fear.
1.2.1
Committee Establishment
The Directorate IRCs are established in PDO:
1.2.2
OSIRC (OSD)
ONIRC (OND)
DOIRC (TWM)
TSIRC (TSD excluding TWM)
HIRC (HD)
XIRC (XD)
FIRC (FD)
GIRC (GD)
Composition
Each directorate shall define the permanent members of their IRC, but they will typically be:
1.2.3
The unit director (chairman), who may delegate no lower than a line manager
2-3 Senior department heads (one of which will be vice chairman)
Unit HSE Advisor or Focal Point (facilitator, should have attended Tripod-B Incident
Investigation Course)
Senior representative of the contractor community (optional)
MSEM representative
Other ad-hoc attendees could be invited for specific reviews (e.g.: TTO/13 for lifting operation
incidents, MSEM/15 representative for review of any RTAs)
In case of absence, permanent members shall ensure a suitable delegate attends the IRC to
replace them.
Responsibilities
The IRCs prime responsibilities are:

To review the following classes of HSE incidents for which the directorate is owner, in accordance with
this Procedure
Page 24
High potential near misses (actual severity 0)

Printed 17/08/08
Revision: 2
Effective: Sept 08
Actual severity 2/3 and medium potential
Actual severity 4/5 and high potential incidents which have first been reviewed by MD-IRC will
have a final review and close out by the relevant Directorate IRC.
To ensure consistently high quality incident investigation by the line
To review incidents to a level of detail commensurate with incident potential severity, as determined
from the Incident Potential Matrix.
To review and endorse the actual severity and potential risk rating provisionally assigned to each
incident.
To endorse corrective and remedial action items to prevent reoccurrence of similar incidents. To assign
appropriate action parties and deadline for close out.
Note: assigned action parties outside the Directorates direct control shall formally agree to accept the
action item.
To define the lateral learning items that are to be communicated to others and ensure their rapid and
effective promulgation.
1.2.4
Meetings
Meetings may be held weekly at a fixed day/time, and could take place in the interior where incidents
occur. However, if no incidents occurred, the unit Director can decide to cancel the meeting.
Directorates that, due to the nature of their operations, have relatively few incidents, a monthly or 2weekly period is acceptable.
A typical IRC agenda could include the following items (at the discretion of the unit Director):
An
Review status of LTI reports and action items for the directorate
Review of new HSE Incidents
Learning from MDIR and other IRCs
incident should be reviewed within 2-3 weeks of the incident occurring. For an incident to be
reviewed by the IRC, the investigation and draft final report shall be completed and issued to all
IRC members prior to the meeting.
Incidents that have first been reviewed by MDIR shall be reviewed by the Directorate IRC (from which
the incident originated) within 2-3 weeks of the MDIR session. The incident investigation and
report (taking the MDIR proceedings into account) shall be completed before that time.
1.2.5
Lessons Learned
Lateral lessons from each IRC session should be prepared and issued within one week of the
meeting. Records should as a minimum include the following for each incident that has been
reviewed:
Incident reference no.

Actual Severity
Potential
Brief incident description (including details on the consequences to People, Assets,
Environment and Reputation)
Immediate and Underlying Causes
Actions to prevent recurrence (with action party and due date)
Lateral learning (Lessons Learned) to be communicated
These lessons shall be issued within each Directorate and copied to Focal Points of all IRCs,
assigned action parties and MSEM (MSEM, MSEM/13/42/43).
Page 25
Printed 17/08/08
Revision: 2
Effective: Sept 08
IRC Focal-Points should ensure that the agreed lateral lessons of key incidents are issued to
MSEM/13 within one week of each review as per the standard format provided. MSEM/13 will
quality check and issue Lateral Learning sheets for wider dissemination.
LTI Briefing Packs shall be prepared for those incidents with particular high lateral learning
value. The draft for these packs shall be made the incident owner, with assistance of IRC
Focal-Point, prior to being issued to MSEM/13 for quality checks. Final Briefing Packs will be
issued by MSEM by MSEM/43, but may be issued internally (within directorate or asset team)
by the IRC Focal-Point
4:
Definitions and Explanation of Terms

(as per ICIR Manual December 31, 2007)
Asset Damage
A direct loss of or damage to plant, equipment, tools or materials resulting from an incident. (Refer to
guidance and examples in Appendix 6 of the ICIR).
Business
One of the global Shell businesses, i.e. Exploration and Production, Downstream or Gas and Power.
Business Travel
For a PDO employee, Business Travel is any travel undertaken for the purposes of work activities in
which that person is engaged in the interests of his or her employer, to the following extent:
It includes the period from the time that person leaves their residence or their normal place of
work until they return or until the time they arrive at their destination and check into temporary
accommodation (home away from home).
It includes, on the return trip, the period from when the person checks out of their temporary
accommodation until they arrive at their residence or their normal place of work.
It includes the whole spectrum of travel, from international travel through to simple acts like
crossing a public road on foot between two company buildings.
It excludes a persons normal commute to work.
It includes travel to the airport for a business trip from the time an employee leaves home even
if that travel follows the same route as their normal commute. If the employee stops in the
office first to work, then the period of employees business travel starts from the office and not
their home.
It excludes that persons commute from their home away from home to their temporary place of
work or a significant detour made for personal reasons.
Any injury or illness occurring during the business trip is considered to be work related for
recording, investigation and learning purposes; but not all injuries and illnesses will be
recordable for statistical purposes.
Business Travel - Contractor

For a PDO contractor, Business Travel is any travel undertaken for the purposes of work activities in
which the contractor is engaged in supplying Shell or one of its subsidiary companies with goods and /
or services, to the following extent:
It includes day-to-day travel undertaken by a Shell contractor in the course of carrying out Shell
work-related activities.
It excludes day-to-day travel undertaken by the Shell contractor when that person is not
engaged in Shell work related activities (such as their normal commute, or any travel
undertaken in the interest of their own employer).
Page 26
Printed 17/08/08
Revision: 2
Effective: Sept 08
It includes contractor mobilization and demobilization when performed under contract with PDO
Business Unit
Activities in one of the Group businesses that are operated as a single economic entity. A business unit
can coincide with a Group company or straddle part or all of several companies.
Consequential Business Loss
The indirect loss associated with incidents resulting in asset damage, environmental impact or impact
on company reputation. It comprises elements such as loss of production (expressed as profit margin),
process unit downtime, product quality costs, cost of environmental clean up, cost of recovery/disposal
of waste and cost of reprocessing off-grade material.
The intention is to estimate the order of magnitude of the loss so that the incident can be assessed on
the RAM and the appropriate resources put into investigation. It should not be necessary to conduct a
detailed accounting of the full range of indirect costs. Consequential business loss should be estimated
on a 100% equity basis.
When consequential business loss results from an incident with impact on the environment or company
reputation, the consequences should be assessed under both asset damage and the
environmental/reputation categories of the RAM and the highest rating used to determine the extent of
investigation and follow up.
Company
Company or Group company means a Shell company, a Joint Venture under operational control (JVuoc), or a Joint Venture not under operational control (JV-nuoc) that has agreed to report its HSE
performance and incident data to Group following the reporting methodology detailed in this guide.
Contractor
All parties working for the company either as direct contractors or as subcontractors.
Environmental Impact
The negative impact on the environment resulting from an incident. (Refer to guidance and examples
in Appendix 7 of the ICIR).
Exposure Hours
The total number of hours of employment including recorded overtime and training but excluding leave,
sickness and unrecorded overtime hours. Exposure hours should be calculated separately for company
and contractor personnel.
Time off duty, even if this time is spent on company premises, is not included in the calculation of
exposure hours, but incidents during this time should be recorded and investigated. When they meet
the work related definition, they should be included in the statistics as recordable incidents.
In many company sites the number of exposure hours can be calculated from computer controlled
access or time keeping records. In the absence of more accurate methods exposure hours can also be
calculated from a headcount and nominal working hours per person or time writing systems.
In order to meet reporting schedules, exposure hours can be estimated on the basis of the previous
data. Corrections can be made at the end of the reporting year when more time is available.
Fatality
A death resulting from a work related injury or occupational illness, regardless of the time intervening
between the incident causing the injury or exposure or causing illness and the death.
FAR
The number of fatalities per hundred million exposure hours.
FIM
Fountain Incident Management (FIM) is the Group system for recording incident details, the
investigation, classification and action items. It can also issue notifications and reports. Other systems
can be used in the interim; but all Businesses and Functions are expected to be using FIM by end
Page 27
Printed 17/08/08
Revision: 2
Effective: Sept 08
2009. FIM should be used for all potentially work related incidents including those that occur while in
home away from home status.
Fires and Explosions
Normally taken to mean all fires that necessitated the use of a fire extinguisher or other extinguishing
means, e.g. snuffing steam, shut off fuel or switch off electricity supply. Fires with no visible flame, e.g.
oil soaked insulation, should also be included. All flammable explosions or overpressure explosions
should be included, irrespective of the extent of containment.
First Aid
An incident is classified as a First Aid if the treatment of the resultant injury or illness is limited to one
or more of the 14 specific treatments. These are:
1. Using a non-prescription medication at non-prescription strength
(2)
2. Administering tetanus immunizations;

3. Cleaning, flushing or soaking wounds on the surface of the skin;
4. Using wound coverings such as bandages, Band-AidsTM, gauze pads, etc.; or using butterfly
bandages or Steri-StripsTM.
5. Using hot or cold therapy;
6. Using any non-rigid means of support, such as elastic bandages, wraps, non-rigid back belts,
etc;
7. Using temporary immobilization devices while transporting an accident victim (e.g., splints,
slings, neck collars, back boards, etc.).
8. Drilling of a fingernail or toenail to relieve pressure, or draining fluid from a blister;
9. Using eye patches;
10. Removing foreign bodies from the eye using only irrigation or a cotton swab;
11. Removing splinters or foreign material from areas other than the eye by irrigation, tweezers,
cotton swabs or other simple means;
12. Using finger guards;
13. Using massages; or
14. Drinking fluids for relief of heat stress.
Note: When determining whether a prescription medicine was used the normal practise is to apply
the definitions used in the country where the incident occurred. However, when making this
classification it should be remembered that the intent is to distinguish those more severe situations
that require a medical practitioner to use strong antibiotics and painkillers from those that only
require first aid. The definition of Prescription Medication may be used as guidance in making
decisions between those that are strong antibiotics and painkillers from those that only require first
aid.
For medications available in both prescription and non-prescription form, a recommendation by a
physician or other licensed health care professional to use a non-prescription medication at
prescription strength is considered medical treatment. The definition of Prescription Medication
may be used to determine when the prescription strength threshold has been crossed.
(2)
First Aid Case (FAC)

Any work related injury that involves neither lost workdays, restricted workdays or medical treatment
but which receives First Aid treatment. (Refer to relevant definitions in Appendix 3 PR1418 Part 1).
High Risk Incident (HRI)
An incident for which the combination of potential consequences and probability are assessed to be in
the high risk (red shaded) area of the RAM. HRIs can be incidents that result in injuries, illnesses or
damage to assets, the environment or company reputation, or they can be near misses.
Page 28
Printed 17/08/08
Revision: 2
Effective: Sept 08
Incident
An unplanned event or chain of events that has, or could have, resulted in injury or illness or damage
to assets, the environment or company reputation.
Incidents do not include operations, maintenance, quality or reliability incidents which had no HSE
consequence or potential. Incidents do not include degradation or failure of plant or equipment resulting
solely from normal wear and tear.
Injury
Any injury such as a cut, fracture, sprain, amputation etc. that results from a single instantaneous
exposure.
Lost Time Injuries (LTI)
The sum of injuries resulting in fatalities, permanent total disabilities and lost workday cases, but
excluding restricted work cases and medical treatment cases.
Lost Time Injury Frequency (LTIF)
The number of lost time injuries per million exposure hours.
Lost Workday Case (LWC)
Any work related injury that renders the injured person temporarily unable to perform their normal work
or restricted work on any day after the day on which the injury occurred. Any day includes rest day,
weekend day, scheduled holiday, public holiday or subsequent day after ceasing employment.
A single incident can give rise to several lost workday cases, depending on the number of people
injured as a result of that incident.
Lost Workdays (LWD)
The total number of calendar days on which the injured person was temporarily unable to work as a
result of a lost workday case.
In the case of a fatality or permanent total disability no lost workdays are recorded.
Medical Treatment (MT)
An incident is classified as Medical Treatment (MT) when the management and care of the patient to
address the injury or illness is above and beyond First Aid (i).
Medical Treatment does not include:
The conduct of diagnostic procedures, such as x-rays and blood tests, including the
administration of prescription medications used solely for diagnostic purposes (e.g., eye
drops to dilate pupils);
Visits to a physician or other licensed health care professional solely for observation or
counselling;
The following may not involve any treatment but for purposes of severity classification, will be recorded
as Medical Treatment.
Any loss of consciousness
Significant injury or illness diagnosed by a physician or other licensed health care

professional for which no treatment is given or recommended at the time of diagnosis.
Examples include punctured eardrums, fractured ribs or toes, byssinosis and some types of
occupational cancer.
Needle stick injuries and cuts from sharp objects that are contaminated with another
persons blood or other potentially infectious material.
Occupational hearing loss.
Medical removal under a government standard (use the Shell Health Guidelines where no
government standard exists).
(i)
Note: First Aid carries a very specific meaning for this purpose.
definition of First Aid.
Page 29
Please refer to the

Printed 17/08/08
Revision: 2
Effective: Sept 08
The following examples are generally considered medical treatment.

Work- related injuries for which this type of treatment was provided or should have been provided are
almost always recordable for Group's statistics:
Treatment of infection
Application of antiseptics during second or subsequent visit to medical personnel
Treatment of second or third degree burn(s)
Application of sutures (stitches)
Application of butterfly adhesive dressing(s) or steri strip(s) in lieu of sutures
Removal of foreign bodies embedded in eye
Removal of foreign bodies from wound; if the procedure is complicated because of depth
of embedment, size, or location
Use of prescription medications (except a single dose administered on the first visit for
minor injury or discomfort)
Use of hot or cold soaking therapy during the second or subsequent visit to medical
personnel
Application of hot or cold compress(es) during the second or subsequent visit to medical
personnel
Cutting away dead skin (surgical debridement)
Application of heat therapy during the second or subsequent visit to medical personnel
Use of whirlpool bath therapy during the second or subsequent visit to medical personnel
Positive X-ray diagnosis (fractures, broken bones, etc.)
Admission to a hospital or equivalent medical facility for treatment or observation for
more than 12 hours.
The following procedures by themselves are not considered medical treatment:
Administration of tetanus shot(s) or booster(s). However, these shots are often given in
conjunction with more serious injuries; consequently, injuries requiring these shots may
be recordable for other reasons
Diagnostic procedures, such as X-ray or laboratory analysis, unless they lead to further
treatment.
Loss of Consciousness
If an employee loses consciousness as the result of a work-related injury, the case must be recorded
as at least an MTC no matter what type of treatment was provided. The rationale behind this is that
loss of consciousness is generally associated with the more serious injuries.
Medical Treatment Case (MTC)
Any work related injury that involves neither lost workdays or restricted workdays, but which receives
Medical Treatment. (Refer to relevant definitions in Appendix 3).
Near Miss
An incident that could have caused illness, injury or damage to assets, the environment or company
reputation, or consequential business loss, but did not.
Non Accidental Death
A death from any cause other than from a work related incident.
Occupational Illness
Page 30
Printed 17/08/08
Revision: 2
Effective: Sept 08
Any abnormal condition or disorder of an employee, other than one resulting from an occupational
injury, caused by exposure to environmental factors associated with employment. An illness is workrelated if the balance of probability is 50% or more that the case was caused by exposures at work.
Occupational illnesses include acute and chronic illness or diseases that may be caused by inhalation,
absorption, ingestion or direct contact with the hazard, as well as exposure to physical and
psychological hazards. (Refer to guidance and examples in Appendix 4 ICIR).
OSHA occupational illness cases will be captured for benchmarking purposes in FIM (and other
systems where possible).
Operational Control
See Instructions on Determining Operational Control Appendix 5 of the PMR
Permanent Total Disability (PTD)
Any work related injury that permanently incapacitates an employee and results in termination of
employment.
Prescription Medication
1. All antibiotics, including those dispensed as prophylaxis where injury or illness has occurred to the
subject individual.
Exceptions: Dermal applications of Bacitracin, Neosporin, Polysporin, Polymyxin, Iodine or similar preparation.
2. Diphenhydramine (Benadryl) greater than 50 milligrams( mg.) in a single application.

3. All analgesic and nonsteroidal anti-inflammatory medication (NSAID) including:
Ibuprofen (such as AdvilTM) - Greater than 467 mg. in a single dose.
Naproxen Sodium( such as AleveTM-) Greater than 220 mg. in a single dose.
Ketoprofen (such as Orudis KTTM) - Greater than 25mg. in a single doge.
Codeine analgesics (Cocodamol, Panadeine, etc.) Greater than 16 mg. in a single dose.
Exceptions: acetylsalicylic acid (Aspirin) and acetaminophen (paracetamol) are not considered medical treatment.
4. All dermally applied steroid applications. Exceptions: hydrocortisone preparations in strengths of 1%

or less.
5. All vaccinations used for work-related exposure. Exceptions: Tetanus
6. All narcotic analgesics (except codeine as listed above)
7. All bronchodilators. Exceptions: Epinephrine aerosol 5.5 mg./ml or less
8. All muscle relaxants (e.g. benzodiazepines, methocarbamol and cyclobenzaprine).
9. All other medications (not listed above) that legally require a prescription for purchase or use in the
state or country where the injury or illness occurred.
Note: Where there are apparent contradictions, advice should be sought from a Company physician
and reasoning documented.
Potential Incident
An unsafe practice or a hazardous situation that could result in an incident (incident has not occurred).
Reputation Impact
The negative impact on company reputation resulting from an incident. The negative impact can be in
the form of adverse attention from media, politicians or action groups, or in public concern about
company activities. (Refer to guidance and examples in Appendix 8).
Restricted Work
Any work related injury or illness that keeps the employee from performing one or more of the routine
functions associated with their job or a physician recommends that the employee not perform one or
more of their job's routine duties.
Restricted Work Case (RWC)
Page 31
Printed 17/08/08
Revision: 2
Effective: Sept 08
Any work related injury which results in Restricted Work.

Restricted Workdays (RWD)
The total number of calendar days counting from the day of starting restricted work (not counting the
day of injury / illness) until the person returns to his normal work.
When restricted workdays follow a period of lost workdays, the restricted workdays are recorded in
addition to the lost workdays, but the injury is recorded as a lost workday case only.
Risk Assessment Matrix (RAM)
A tool that standardises qualitative risk assessment and facilitates the categorisation of risk from
threats to people, assets, environment and company reputation. The tool is described in detail in the
Risk Assessment Matrix (2006).
Road Transport Incident
An incident involving a vehicle driven by a company or contractor employee, whether on or off the
road, that has resulted in injury, illness or damage to assets, the environment or the company's
reputation, irrespective of the cost of repair or responsibility for cause.
A vehicle is defined as a car, van, light vehicle, heavy goods vehicle, road tanker, bus, motorcycle or
any unit under tow, e.g. trailers, caravans, mobile generators.
This definition does not include:
Incidents involving vehicles operating on aprons of public airfields;

Damage as a result of normal wear and tear, e.g. minor paint scratches, stone chips, and
mechanical wear and tear;
Incidents which occur when the vehicle was unattended, e.g. vandalism or other damage whilst
the vehicle was parked. These would be considered as incidents rather than transport incidents.
Significant Incidents
Incidents with actual consequences that rate 4 or 5 on the RAM. (people, environment, damage or
reputation).
Third Parties
Persons or organisations that are not employed by or contracted to a company or contractor.
Total Sickness Absence
Absence from work on grounds of incapacity to work due to any sickness and injury, work related or
not, expressed as percentage of total workdays available. All other cases of absence such as
pregnancy, childbirth, leave, training and seminars, are not included in the definition of absence.
Total Recordable Cases (TRC)
The sum of injuries resulting in fatalities, permanent total disabilities, lost workday cases, restricted
work cases and medical treatment cases.
Total Recordable Case Frequency (TRCF)
The number of Total Recordable Cases per million exposure hours.
Total Recordable Occupational Illness (TROI)
The sum of all recordable occupational illnesses. Cases involving no lost or restricted workdays and no
medical treatment or first aid are included. A single exposure can give rise to several occupational
illness cases. Contractor occupational illness cases are to be reported when known, but are not to be
included in the TROIF.
Total Recordable Occupational Illness Frequency (TROIF)
The number of employee occupational illnesses per million exposure hours.
Vehicle Kilometres Driven
The number of vehicle kilometres travelled during work related activities whilst being driven by a
company or contractor employee
Page 32
Printed 17/08/08
Revision: 2
Effective: Sept 08
Work Related
An injury or illness must be considered work related if an event or exposure in the work environment
caused or contributed to the resulting condition or significantly aggravated a pre-existing injury or
illness. Work relatedness is presumed for injuries and illnesses resulting from events or exposures
occurring in the work environment unless one of the following exceptions applies in its entirety:
Occurs when an employee or contractor is present in the work environment as a member of the
general public. In this case it will be included in the 3 rd party statistics.
Results solely from voluntary participation in a wellness program or in a medical, fitness, or

recreational activity such as blood donation, physical examination, flu shot, exercise class,
racquetball, or baseball. On the other hand, if the employee was injured by a trip or fall hazard
present in the employers lunchroom, the case would be considered work-related.
Involves signs or symptoms that surface at work but result solely from a non-work related event
or exposure.
Is solely the result of eating, drinking, or preparing food or drink for personal consumption
(whether bought on the employers premises or brought in). For example, if the employee is
injured by choking on a sandwich while in the employers establishment, the case would not be
considered work-related. Note: If the employee is made ill by ingesting food contaminated by
workplace contaminants (such as lead), or gets food poisoning from food supplied by the
employer, the case would be considered work-related.
Is solely the result of doing personal tasks at the establishment outside of the employees
assigned working hours
Is solely the result of personal grooming, self medication for a non-work-related condition. Or is
intentionally self-inflicted
Is caused by a vehicle accident and it occurs on a company owned parking lot or road while the
employee is commuting
Is the common cold or flu (Note: contagious diseases such as tuberculosis, brucellosis,
hepatitis A, or plague are considered work-related if the employee is infected at work).
Is not a Shell occupational stress case.
Shell uses a wider definition of stress than does OSHA.

The OSHA definition of work relatedness excludes a mental illness (unless it is post-traumatic stress
syndrome where it can be tied to a specific workplace incident, or are incidents where the employee
voluntary provides an opinion from a physician or other licensed health care professional stating the
employees mental illness is work-related).
5:
Page 33
INCIDENT REPORT TEMPLATES

Appendix 1
High Potential Incident Reports
Appendix 2
Non-accidental Death Reports
Appendix 3
General Medium Potential Incident Report
Appendix 4
Road Traffic Medium Potential Incident Report
Appendix 5
List of Activity at time of Incident
Appendix 6
Broad Incident Types
Appendix 7
List of Immediate Causes
Appendix 8
List of Underlying Causes
Appendix 9
List: Facilities / Plant / Equipment
Appendix 10
List of Injury / Occupational Illness
Appendix 11
Classification of Occupational Illnes
Printed 17/08/08
Appendix 1:
Revision: 2
Effective: Sept 08
High Potential Incident Reports
The contents of High Potential Incident reports should be based on the following template or
alternatively the Tripod Beta report format can be printed if a complete Tripod Beta analysis has been
done:
(This is the information required by PDO and SIEP.)
1.
SUMMARY
2.
INCIDENT DETAILS
3.
2.1
Time, Date, Place
2.2
Persons involved in the Incident
2.3
Vehicles / equipment involved in the Incident
2.4
Events leading to the Incident
2.5
The Incident
2.6
Description of damage
2.7
Nature of injuries
2.8
Post Incident response
INCIDENT INVESTIGATION
3.1
Investigation Team
3.2
Examination of site conditions
3.3
Examination of vehicles / equipment (including maintenance)
3.4
Examination of the work preparation / work task analysis
3.5
Experience, competence and other details of persons involved in Incident
3.6i
Sections to address any other issues specific to nature of Incident
3.6ii
e.g.
3.6iii
Explicitly describe what action has been taken to determine if alcohol or drug use
Supervision, Procedures, Permit to WorkJourney Management etc.
was involved
4.
5.
3.7
Response to the Incident
3.8
Incident Tree
SAFETY CASE GOVERNING OPERATION / ACTIVITY

4.1
Is activity addressed in Safety Case, and were hazards adequately recognised?
4.2
Were recommended hazard / threat control measures implemented?
HSE MANAGEMENT
5.1
Page 34
Organisation, roles and responsibilities

5.1.1
PDO
5.1.2
Contractor / Contract
5.2
HSE requirements for contract
5.3
HSE Plans (focus on issues which are implicated in causes of Incident)

5.3.1
PDO
5.3.2
Contractor
Printed 17/08/08

5.4
Revision: 2
Effective: Sept 08
Monitoring implementation of HSE Plans

5.4.1
PDO monitoring if PDO is fulfilling responsibilities and obligations
5.4.2
PDO monitoring if Contractor is fulfilling responsibilities and obligations
5.4.3
Contractor monitoring if it is fulfilling responsibilities and obligations

(above sections include monitoring, auditing, inspections, reviews etc.).
5.5
HSE performance of contractor

(On contract in question and other contracts in general. Alternatively, address
PDO HSE performance if a PDO fatality)
6.
CONCLUSIONS
7.
6.1
Primary or Immediate cause of the Incident
6.2
Underlying or Contributory causes
6.3
General conclusions and observations
RECOMMENDATIONS
7.1
Immediate actions
7.2
Follow-up actions
LIST OF ATTACHMENTS (including action Close-Out form template)

Appendix 2:
Non-accidental Death Reports
Where non-accidental death occurs to a person who is currently employed by, or on contract to, the
Company, records of medical pre-employment checks, periodic medical checks, information about
the work and work conditions preceding the death should, if available be subject to investigation.
This also applies to non-accidental deaths outside normal working hours. The objective of this
investigation is to ascertain whether the cause of the fatality relates to systems and conditions
which are managed by the Company and may provide the grounds for corrective action. If this is
the case, such a fatality should be reported immediately and be included in the Company statistics.
The contents of Non-accidental death reports should be based on the following template where
relevant. This is the information required by PDO and SIEP.
1.
SUMMARY
2.
EVENT DETAILS
2.1 Time, Date, Place of Death
2.2 Details of the Deceased
2.3 Nature of injuries/cause of death
2.4 Sequence of Events leading to the discovery of the deceased
2.5 Sequence of Events following the discovery of the deceased
2.6 Post Incident response
2.6.1
Where death occurred within the Company fence, were the Company
Medical
Emergency Response (including First Aid, Medical Treatment and Medevac )
procedures suitable and complied with?
3.
Page 35
INVESTIGATION DETAILS
Printed 17/08/08
Revision: 2
Effective: Sept 08
3.1 Investigation Team (including medical officer or occupation health adviser)

3.2 Persons Interviewed
3.3 Examination of relevant site / living conditions (vehicles, equipment,
accommodation, etc.)
3.4 Examination of the work hazards
3.4.1 Are there any work related exposures e.g. contact with hazardous
substances, poor working environment etc. which could have contributed
to the death?
3.5 Evaluation of pre-existing conditions / lifestyle factors
3.5.1 Are there any relevant lifestyle factors e.g. diet, tobacco, alcohol abuse,
etc.?
3.5.2 Are there any pre-existing medical conditions?
3.5.3 Has the individual been declared medically fit to carry out his/her normal
duties in compliance with Company Standards?
3.5.4 Had the individual exhibited any signs, or symptoms associated with the
cause of death before/during his/her recent work period?
3.5.5 Had the individual been recently referred to a Doctor?
HEALTH MANAGEMENT ASPECTS
4.
4.1 Organisation, roles and responsibilities

4.1.1
PDO & Contractor
4.1.2
What is known of the health management within the direct working
environment of the deceased (health risk assessments, exposure monitoring,
health controls and performance indicators.)
4.2 Health requirements for contract
4.3 HSE Plans (PDO & Contractor) (focus only on issues which are relevant to the
cause of death)
4.4 Monitoring and Implementation of HSE Plans
4.4.1
PDO monitoring if PDO is fulfilling responsibilities and obligations
4.4.2
PDO monitoring if Contractor is fulfilling responsibilities and
obligations
4.4.3
Contractor monitoring if it is fulfilling responsibilities and obligations

(above sections include monitoring, auditing, inspections, reviews
etc.).
5.
CONCLUSIONS
5.1
Primary and Contributory cause(s) of the Death
5.2
General conclusions or observations
6.
RECOMMENDATIONS
6.1
Immediate actions
6.2
Follow-up actions
LIST OF ATTACHMENTS
Appendix 3:
information such as autopsy report, medical fitness certificate, etc. if available)
including action Close-Out form template
General Medium Potential Incident Report
General Medium Potential Incident Report Form

Page 36
Printed 17/08/08
Revision: 2
Effective: Sept 08
REPORTING DEPARTMENT :
DATE OF INCIDENT :
TIME OF INCIDENT :
INCIDENT LOCATION :
CONTROLLED BY :
PDO INCIDENT SEVERITY (0, 1, 2, 3, 4 or 5) :

[
] PDO
] CONTRACTOR
] THIRD PARTY
] INJURIOUS
] OCC. ILLNESS
] EQUIP. DAMAGE/OTHER
] NEAR MISS
] Potential Risk Rating
ACTIVITY AT TIME OF INCIDENT
BROAD TYPE OF INCIDENT
[ ] Using Portable Tools, Equipment

[ ] Welding / Burning
[ ] Loss of Containment
[ ] Falling Objects
[ ] Manual Lifting / Handling
[ ] Fire and Explosion
[ ] Electrical
[ ] Cleaning
[ ] Pollution Environment
[ ] Assault
[ ] Operating Plant / Machinery
[ ] Air Transport
[ ] Unsafe
[ ] Digging
Act/Condition
[ ] Handling Hazardous Materials
[ ] Sea Transport
[ ] Lifting / Crane
[ ] Sampling
Operations
[ ] Dismantling / Assembling
[ ] Slips/Trips/Falls
[ ] Draining / Flushing
[ ] Theft & Sabotage
[ ] Other:
[ ] Scaffolding
[ ] Disconnecting
[ ] Climbing / Descending
[ ] Connections
[ ] Walking at Same Level
[ ] Diving
[ ] Piloting
[ ] Other:
[ ] Working at High Level
PARTIES INVOLVED
PDO DEPARTMENT / SECTION:
PDO CUSTODIAN :
CONTRACTOR / SUB-CONTRACTOR:
CONTRACT NUMBER:
THIRD PARTY (NAME):
TOTAL NUMBER INJURED
Page 37
Printed 17/08/08
Revision: 2
Effective: Sept 08
HOW THE INCIDENT OCCURRED

(Attach sketch / photographs / Event Tree * as appropriate more paper may be used if required).
Is the Activity and its associated Hazards / Controls adequately addressed in the applicable Safety Case(s)
[Y/N}? :[ ]
If 'No', state measures proposed to rectify :
What actions were taken to determine if alcohol or drug use contributed to the Incident?
* Required for all High Potential Incidents
IMMEDIATE ACTION TAKEN TO PREVENT RECURRENCE
DETAILS OF INJURED PARTIES (to be completed by Medical Department)

INCLUDE:
NAME
DATE OF BIRTH
EMPLOYEE NO.
EMPLOYER
INJURY CLASS (if RWC state alternate work assigned)
NATURE OF INJURY / ILLNESS
PART OF BODY
EST. DATE FOR RETURN TO NORMAL WORK :
MEDICAL OFFICER :
Deemed fit to return to work on
SIGNED :
(if LTI or RWC)

DATE :
/ /
Signed:
Medical Officer:
COST INCURRED AS A RESULT OF THIS INCIDENT (US$) :

PROPERTY DAMAGE:
ENVIRONMENTAL IMPACT : (YES/NO)
PRODUCT LOSSES :
DESCRIPTION :
Page 38
Printed 17/08/08
Revision: 2
Effective: Sept 08

DETAILS OF EQUIPMENT DAMAGED
TYPE OF FACILITY :
EQUIPMENT PART :
TYPE OF PLANT / EQUIPMENT :
EQUIPMENT TAG NR :
PHASE OF OPERATION :
DETAILS OF LEAKING EQUIPMENT
LEAKING ITEM
]
HAZARDOUS (Y/N)
DURATION OF LEAK (MIN)
INITIAL PRESSURE (KPa)
LEAK AREA (M2)
LEAK STOPPED (AUTO / MANUAL)
FINAL PRESSURE (KPa)
DID DETECTION SYS.OPERATE (Y/N)[
REASON FOR DETECTION FAILURE :

FIRE / EXPLOSION
DURATION (MIN)
EXTINGUISHED (AUTO / MANUAL)
EXTINGUISHING MEDIUM
DID DETECTION OPERATE ? (Y/N)
REASON FOR DETECTION FAILURE:
Page 39
Printed 17/08/08
Revision: 2
Effective: Sept 08

IMMEDIATE CAUSE
[ ] Information Error or Omission
[ ] Influence of intoxicating substances
UNDERLYING CAUSE
[ ] Inadequate physical / mental
capability
[ ] Failure to follow rules / procedures;
[ ] Inadequate knowledge / skill
[ ] Inadequate equipment / tools
[ ] Excessive stress
specify :-
[ ] Improper motivation
[ ] Misuse of equipment / tools
[ ] Inadequate supervision
[ ] Procedure not documented
[ ] Inadequate policy, safety plan
[ ] Work environment
[ ] Inadequate planning, organisation
[ ] Procedure considered impractical
[ ] Inadequate procedures, work
[ ] Untidy Site (Poor housekeeping)
standards
[ ] Procedure not communicated
[ ] Inadequate engineering design
[ ] Access
[ ] Inadequate maintenance,
[ ] Other
inspection
[ ] External factors, 3rd party, weather

[ ] Inadequate warning, safety devices
[
Other:_________________________________
[ ] Other:
[ ] Failure to observe / use warning safety devices
[ ] Lack of due care and attention
[ ] Improper manual handling
[ ] Attack by animal
[ ] Inadequate PPE
[ ] Fatigue / Stress
[ ] Failure to wear PPE
[ ] Lack of safety awareness
[ ] None of the above, specify:____________________________
ACTION TAKEN TO PREVENT RECURRENCE Further Recommendations are attached

ITE
M
NO.
Page 40
CORRECTIVE ACTION
PDO
ACTION
PARTY
TARG
ET
DATE
STATUS
Printed 17/08/08
Revision: 2
Effective: Sept 08
REPORT WRITER SUPERVISOR'S NAME :
REF IND.:
SIGNED:
PDO INCIDENT OWNER'S NAME
REF. IND.:
SIGNED :
DATE REPORT COMPLETED :
RECOMMENDATIONS
DATE OF INCIDENT :
INCIDENT :
Number
Description of Action
Action Party
Due by
SIGNED REPORT WRITER :
INCIDENT REVIEW COMMITTEE COMMENTS - APPEND TO REPORT ORIGINAL
DATE OF REVIEW :
REVIEW (Y/N) : [
ARE THE DETAILS OF THE INCIDENT ADEQUATE FOR
REVIEW COMMITTEE COMMENTS :
Page 41
Printed 17/08/08
Revision: 2
Effective: Sept 08
SIGNED CHAIRMAN OF INCIDENT REVIEW COMMITTEE :
Page 42
Printed 17/08/08
Revision: 2
Effective: Sept 08

Guidance on the General Medium Potential Incident Report Form
The General Incident Report Form is used to report all types of Medium potential Incidents except Road
Traffic Incidents.
Efforts must be made to provide all information requested. Draw a line through any section that is not
applicable.
The General Incident Report Form is to be signed by the PDO supervisor responsible for completing the
report, and the Incident Owner responsible for review and approval of the completed report.
The sections 'Details of Injured Parties' and 'Review Committee Comments' are not to be completed by
the PDO supervisor. These sections are to be completed by the PDO Medical Department and the
Secretary of the Incident Review Committee respectively. Routing is as prescribed on the Form's cover
sheet.
Heading
Details Required
Reporting Department
State the Reference indicator for the PDO reporting department.
Incident Location
State the general area followed by the specific locations e.g. Yibal/GGP
etc.
Location Controlled by
Tick PDO if is predominantly controlled by the Company (e.g. Production

Station).
Tick Contractor if
Construction Site)
predominantly
controlled
by Contractor
(e.g.
Tick Third Party if neither applies.

Activity at Time of Incident
Tick the box against the action which had led directly to the occurrence
of the Incident. This is not necessarily the action of the injured parties (if
any). Refer to Appendix 4.4 for Definition of Activities.
Broad Type of Incident
Tick the box against the general type of Incident. Refer to Appendix 4.5
for Definitions of Broad Incident Types.
Parties Involved
Identify all parties involved that have or possibly have contributed to the
Incident or have suffered from its consequences (injury/damage).
How the Incident Occurred
Describe how the Incident occurred. This will be based on results from
your investigation and must include:
- the reasons for carrying out the work
- events leading up to the Incident
- the Incident description and injury and/or
damage incurred.
State whether the Activity underway at the time of the Incident and
its associated hazards / controls are adequately addressed in the
applicable Safety Case(s). Does the Safety Case need updating?
The Report form may not provide enough space for the full
description. In this case, state that you have provided additional
information (which may include photographs and drawings),and attach
the material securely to the report form.
Immediate Action taken to

prevent recurrence
Page 43
State what has been done as an interim measure to prevent similar

Incidents happening on the site or to personnel carrying out similar
activities. The Action Parties must be listed against each preventative
measure.
Printed 17/08/08
Revision: 2
Effective: Sept 08
Details of Injured Parties

This section is to be completed and signed by the PDO Medical Department. The injury description is to be
signed by the person who had provided the treatment. The following details are to be provided for all injured
parties.
Heading
Details Required
Name
State full name
Date of Birth
State date of Birth or age if unknown
PDO
Reference
indicator(employee)
State as applicable
Contractor
State company name of contractor if applicable
Injury class
FTL, PTD, PPD, LWC, RWC, MTC, FAC, OCC. Refer to Appendix 1 for
definitions. IF RWC, STATE ALTERNATIVE WORK DUTIES ASSIGNED.
Nature of Injury
State nature of injury. Only one entry is allowed. Refer to Appendix 4.9 for
listing of injuries, and the rules in case of multiple injuries.
Part of body
State part of body affected by main injury stated above.
Property Damage
State the approximate costs (RO) of property damage incurred.
Product Losses, clean-up

and restoration costs.
State the approximate cost of product losses including clean-up and

restoration costs. Do not include cost of any deferred production.
Details
of
damaged
equipment
Type of facility
E.g. production stations, construction sites, etc.
Type of plant / equipment

Phase of operation
E.g. compressor, manifold, laboratory

E.g. construction, commissioning, maintenance, operation.
Equipment part
E.g. : flange, hose, gauge
Equipment Number
State the equipment tag number
Details
of
equipment
leaking
Leaking item
State the item of equipment from which the leak occurred e.g. Flange, valve,
drain.
Duration of leak
State duration in minutes.
Hazardous
State yes/no depending on the pressure and nature of the fluids released.
Leak area
State the cross-sectional area of leak (and not of the area affected)
Initial/final pressure
State pressure in vessel prior to and after the leak occurred.
Did detection operate
State yes/no
Leak stopped by
State automatically or manually.
Fire/Explosion
Duration
State duration in minutes.
Extinguished by
State: Automatically, or manually. (Manually includes hand held extinguishers

and fixed or portable systems which require manual activation).
Extinguishing medium
E.g. Water, foam, CO2, BCF, powder
Page 44
Printed 17/08/08
Revision: 2
Effective: Sept 08

Did detection operate
State yes/no
Reason
failure
Briefly describe reason if applicable
for
detection
Immediate cause
The immediate causes relate mainly to the actions of individuals directly

involved in the Incident. Refer to Appendix 4.6 'Immediate Causes' for a
description of the causes listed.
Underlying Causes
The underlying causes can relate to managerial and organisational

weaknesses which allowed the Incident to happen. Tick the appropriate boxes.
Refer Appendix 4.7 'Underlying Causes'.
Action
to
recurrence
prevent
Corrective Action items endorsed by the Incident Review Committee must be

listed. Each item must be identified by a number for ease of follow-up. For
each action item a PDO action party must be nominated by the Committee.
Both the current status and the target completion dates must be recorded.
Review Committee Comments

This section to be completed by the Secretary of the appropriate Incident Review Committee following
discussion at the meeting.
Heading
Details Required
Date of review
State the date on which the Incident was reviewed by the Incident Review
Committee.
Details adequate
State yes/no. If the report is inadequate it should be rejected and returned

with comments to the relevant Incident Owner.
Comments
State any comments by the review committee on the causes, circumstances

and follow-up of the Incident, and the quality of the investigation and the
report.
Appendix 4:
Medium Potential Road Traffic Accident Report
REPORTING DEPARTMENT :
DATE OF INCIDENT :
TIME OF INCIDENT :
WEEK:
INCIDENT LOCATION :
CONTROLLED BY :
ACTUAL SEVERITY (0, 1, 2, 3, 4, 5) :

[
] INJURIOUS
] OCC. ILLNESS
] EQUIP. DAMAGE/OTHER
] NEAR MISS
Potential risk Rating [
Page 45
DAY OF THE
[
] PDO
] CONTRACTOR
] THIRD PARTY
Printed 17/08/08
Revision: 2
Effective: Sept 08
PARTIES INVOLVED
PDO DEPARTMENT / SECTION
PDO CUSTODIAN :
CONTRACTOR / SUB-CONTRACTOR :
INVOLVED ROP INSPECTOR NAME:
THIRD PARTY (NAME)
TOTAL NUMBER INJURED
HOW THE INCIDENT OCCURRED:
Page 46
Printed 17/08/08
Revision: 2
Effective: Sept 08

IMMEDIATE CAUSE
UNDERLYING CAUSE
[ ] Information Error or Omission

[ ] Influence of intoxicating substances
[ ] Failure to follow rules / procedures;
[ ] Inadequate equipment / tools
specify :-
[ ] Inadequate physical / mental

capability
[ ] Inadequate knowledge / skill
[ ] Excessive stress
[ ] Misuse of equipment / tools
[ ] Improper motivation
[ ] Procedure not documented
[ ] Inadequate supervision
[ ] Work environment
[ ] Inadequate policy, safety plan
[ ] Procedure considered impractical
[ ] Inadequate planning,
[ ] Untidy Site (Poor housekeeping)

[ ] Procedure not communicated
[ ] Access
organisation
[ ] Inadequate procedures, work
[ ] Other
standards
[ ] External factors, 3rd party, weather
[ ] Inadequate engineering design
[ ] Inadequate warning, safety devices
[ ] Inadequate maintenance,
[ ] Other:
inspection
[ ] Failure to observe / use warning safety

devices
[
]
Other:_________________________________
[ ] Lack of due care and attention

[ ] Improper manual handling
[ ] Attack by animal
[ ] Inadequate PPE
[ ] Fatigue / Stress
PPE
] Failure to wear
[ ] Lack of safety awareness

[ ] None of the above, specify:BROAD TYPE OF ACCIDENT
[ ] Single car Incident
[ ] Rollover
[ ] Collision with: [ ] Pedestrian
[ ] Animal
[ ] Object on the road [ ] Object beside the road
[ ] Other:
[ ] Two car Incident:

[ ] One vehicle stationary [ ] Both vehicles moving:
[ ] At junction: [ ] Roundabout [ ] X junction
[ ] Y junction
[ ] T junction
[ ] Not at a junction:
[ ] Moving along in same direction
[ ] Moving in opposite direction
[ ] Reversing
[ ] Overtaking
[ ] Multiple car Incident, specify:
Page 47
Printed 17/08/08
Revision: 2
Effective: Sept 08
GENERAL
CONDITIONS
Weather:
Light:
Road:
Quality:
Condition:
Shoulder:
[ ] Clear
[ ] Dawn
[ ] Straight
[ ] Smooth
[ ] Wet
[ ] Shoulder
[ ] Rain
[ ] Daylight
[ ] Bend
[ ] Stony
[ ] Dry
[ ] Windrow
[ ] Fog
[ ] Low Sun
[ ] Incline
[ ] Corrugated
[ ] Washouts
[ ] Profile Flat
[ ] Dust
[ ] Dusk
[ ] Loose
[ ] Dark
[ ] Heavy
Sands
[ ] Profile Up
[ ] Overcast
[ ] Incline
& Bend
SKETCH
[ ] Profile Down
To show;
1. Direction of travel of all involved vehicles, pedestrians, etc.,

2. Point of impact ,
3. Final resting places,
4. Road measurements,
5. Any signposts,
6. Wind direction,
7. Sun position,
8. Skid marks and wheel tracks,
9. Windrows,
10. Road markings,
11. Distances to nearest town/camp,
12. Road gradients,
13 Each vehicle to be numbered for references in this form.
Refer to the Field supervisor's guide to road traffic Incident investigation
A copy of the page below has to be completed for each involved vehicle.
Vehicle number:
Page 48
(As indicated on previous page's sketch)
Printed 17/08/08
Revision: 2
Effective: Sept 08

Vehicle type:
Mode of operation:
Vehicle condition:
Tyre pressure:
[ ] Motor cycle
[ ] 2 Wheel drive
[ ] Head lights
[ ] Front left
[ ] Saloon
[ ] 4 Wheel drive
[ ] Rear lights
[ ] Front right
[ ] Station Wagon
[ ] Seat belts installed for all
[ ] Rear left
[ ] Crewcab
[ ] Seat belts worn by all
[ ] High intensity rear

lights
[ ] Pick up
[ ] Break lights
Head lights
[ ] Light bus
[ ] City lights
[ ] 2 axle truck
[ ] Dipped
[ ] >2 axle truck
[ ] Full High Intensity rear
Was
the
obscured in
visibility
Tick if within 20 KPa

of
correct pressure.
some way (e.g. dirty

windscreen):
lights
[ ] Plant
[ ] Trailer tyres
Tick
if
incorrectly
functioning
[ ] Heavy bus
[ ] Articulated truck
[ ] Spare
[ ] Signal lights
[ ] Off
[ ] Rear right
[ ] Off
[ ] On
VEHICLE
SPECIFICATION
INSPECTION
AND
Last vehicle inspection date:
Licence Plate Number:
(Attach vehicle inspection report)
Date first registered:
Last date driver inspected vehicle:
Owned by:
If mechanical problems may have contributed to the Incident

then the vehicle must be inspected by an expert. Contact
TSL/4 who will arrange for the vehicle to be inspected by an
expert..
Fleet number:
Make:
Estimate vehicle repair cost: OR
Estimate other direct cost: OR
DRIVER
PASSENGERS
Name:
Date of birth:
Names and Company/Dept.
Gender:
Occupation:
Company number:
Nationality:
Company/department:
ROP driving licence:
1.
Type(s):
Number:
Expire date:
Type(s):
PDO driving licence:

Number:
2.
3.
4.
Expire date:
LOAD
Date last eye test driver:
Composition:
Driving experience in Oman:
years
Quantities:
Driving experience in Interior:
years
Secured by:
Date last attended tool box meeting:

Is driver on
alcohol/drugs:
medication/
under
Height to load from road surface:

the
influence
of
Attended driving and road safety courses in last 3 years:
Page 49
Height load bed from road surface:

Quantity spilled/lost:
Printed 17/08/08
Revision: 2
Effective: Sept 08

INJURIES
INJURIES
INJURIES
INJURIES
INJURIES
DRIVER
PASSENGER1
PASSENGER 2
PASSENGER 3
PASSENGER 4
[ ] Head
[ ] Head
[ ] Head
[ ] Head
[ ] Head
[ ] Back
[ ] Back
[ ] Back
[ ] Back
[ ] Back
[ ] Neck
[ ] Neck
[ ] Neck
[ ] Neck
[ ] Neck
[ ] Hip
[ ] Hip
[ ] Hip
[ ] Hip
[ ] Hip
[ ] Leg
[ ] Leg
[ ] Leg
[ ] Leg
[ ] Leg
[ ] Foot
[ ] Foot
[ ] Foot
[ ] Foot
[ ] Foot
[ ] Abdomen
[ ] Abdomen
[ ] Abdomen
[ ] Abdomen
[ ] Abdomen
[ ] Chest
[ ] Chest
[ ] Chest
[ ] Chest
[ ] Chest
[ ] Arm
[ ] Arm
[ ] Arm
[ ] Arm
[ ] Arm
[ ] Hand
[ ] Hand
[ ] Hand
[ ] Hand
[ ] Hand
[ ] Multiple
[ ] Multiple
[ ] Multiple
[ ] Multiple
[ ] Multiple
WORKING CONDITIONS DRIVER
Day of the Incident-
Day before the Incident-
Time of departure from home/rest place:
Hours worked:
Prior to Incident-
of which driving:
Slept at-
Hours worked:
[ ] Home
Hours driven since last break:
[ ] Hotel
Days worked since last full day without work:
[ ] In vehicle
Days to be worked until next full day without

work:
[ ] Outside
of which driving:
Was the vehicle air-conditioned at the time of

the Incident:
[ ] Elsewhere
Time of arrival at rest place/home:
Number of hours slept:
JOURNEY MANAGEMENT SYSTEM

Estimated Time of Departure:
From:
Estimated Time of Arrival:
At:
Journey approved by:

Other details of the Journey Management:
(Attach copy of Journey Management form)
Page 50
Printed 17/08/08
Revision: 2
Effective: Sept 08
THE ABOVE INDICATED INJURIES OF DRIVER(S) AND PASSENGERS ARE CONFIRMED BY THE
UNDER SIGNED
MEDICAL OFFICER
NAME :
REF. IND.:
SIGNED: --------------------------------
REMARKS:
DATE :
ACTION TAKEN TO PREVENT RECURRENCE Further Recommendations are attached

ITEM
NO.
CORRECTIVE ACTION
PDO
ACTION
TARGET
DATE
STATUS
PARTY
REPORT WRITER SUPERVISOR'S NAME :
REF. IND.
SIGNED:
PDO INCIDENT OWNER'S NAME:
REF. IND.:
SIGNED :
DATE REPORT COMPLETED :
RECOMMENDATIONS
DATE OF INCIDENT :
INCIDENT :
Number
Description of Action
Action Party
Due by
SIGNED REPORT WRITER :
INCIDENT REVIEW COMMITTEE COMMENTS - APPEND TO REPORT ORIGINAL
Page 51
Printed 17/08/08
Revision: 2
Effective: Sept 08
DATE OF REVIEW :
REVIEW (Y/N) : [
ARE THE DETAILS OF THE INCIDENT ADEQUATE FOR
REVIEW COMMITTEE COMMENTS :
SIGNED CHAIRMAN OF INCIDENT REVIEW COMMITTEE :
Guidance on Medium Potential Road Traffic Accident Report Form
The Road Traffic Accident Report Form is used to report all types of Incident involving one or more
moving vehicles.
Efforts must be made to provide all information requested. Draw a line through any section that is not
applicable.
The Road Traffic Accident Report Form is to be signed by the PDO supervisor responsible for completing
the report, and the Incident Owner responsible for review and approval of the completed report.
The section 'Review Committee Comments' is not to be completed by the PDO supervisor. This section is
to be completed by the Secretary of the Incident Review Committee. Routing is as prescribed on the
Form's cover sheet.
Heading
Details Required
Reporting Department
State the Reference indicator for the PDO reporting department.
Incident Location
State the general area followed by the specific locations e.g. Yibal/GGP
etc.
Location Controlled by
Tick PDO if it is predominantly controlled by the Company (e.g.

Production Station).
Tick Contractor if
Construction Site)
predominantly
controlled
by
Contractor
(e.g.
Tick Third Party if neither applies.

Parties Involved
Identify all parties involved that have or possibly have contributed to the
Incident or have suffered from its consequences (injury/damage).
How the Incident Occurred
Describe how the Incident occurred. This will be based on results from
your investigation and must include:
- events leading up to the Incident
- the Incident description and injury and/or
damage incurred.
The Report form may not provide enough space for the full
description. In this case, state that you have provided additional
information (which may include photographs and drawings),and attach
the material securely to the report form.
Page 52
Printed 17/08/08
Revision: 2
Effective: Sept 08

Immediate Cause
Tick the applicable boxes. Refer to Appendix 4.6 'Immediate Causes' for
a description of the causes listed.
Underlying Cause
Tick the applicable boxes. Refer to Appendix 4.7 'Underlying Causes'.
Broad Type of Incident
Tick the applicable boxes
General Conditions
Tick the applicable boxes
Sketch
To show:
1. Direction of
2. Point of impact
travel
of
all
involved
vehicles,
etc.
3. Final resting places

4. Road measurements
5. Any signposts
6. Wind direction
7. Sun position
8. Skid marks and wheel tracks
9. Windrows
10. Road markings
11. Distances to nearest town/camp
12. Road gradients
13. Number for all vehicles for reference
Vehicle type
Tick the applicable boxes.
Mode of operation
Vehicle condition

Any obstruction of the visibility related to the vehicle; e.g. dirty
windscreen, spare wheel blocking rear view etc., are to be specified.
Tyre pressure
Tick the applicable boxes if tyre pressure is within 20 KPa (0.2 bar) of
the required pressure.
Vehicle
Vehicle specification and condition
Licence Plate Number
Check details with ROP Motor Vehicle Licence
Date first registered
See ROP Motor Vehicle Licence
Owned by
See ROP Motor Vehicle Licence
Fleet number
Applicable for vehicle used in the interior
Estimate
cost
vehicle
repair
State the amount in OR required to bring the vehicle back in its original
condition
Estimate other direct cost
State cost for removing spills, vehicle replacement costs etc.
Last
driver
inspection date
Drivers are required to regularly carry out simple checks like tyre
pressure. State the date of the last driver inspection.
Driver
Name
Page 53
vehicle
Driver, Passenger and Load

State full Name
Printed 17/08/08
Revision: 2
Effective: Sept 08
Date of Birth
State date of Birth or age if unknown
Gender
Male or Female
Nationality
As stated on the driving licence
Occupation
As stated on the labour card
Company/department
Company: As stated under Sponsor on the labour card. Department: for

PDO staff only.
Company number
Applicable for PDO and some contractors only.
ROP Driving Licence type
Motor cycle, Light, Heavy Goods and/or Heavy Earth Moving Plant.
PDO Driving Licence type
Complete as stated on the PDO driving licence.
Date last eye test
Driver eye test is part of the procedure to obtain a driving licence,

additional test may have been carried out after that time.
Date last attended tool box

meeting
Tool box meetings are held to briefly discuss safety items before work
commences
Is driver under medication/

under the influence of
alcohol/drugs
Please specify the drivers' own statement in this respect.
Attended driving and road

safety courses in the last 3
years
Courses like the Interior driving skill course may have been attended by
the driver, please specify.
Also specify if any testing for the presence of alcohol has been done.
Passengers
Names
State Full Names
Company/department
Company: As stated under Sponsor on the labour card/department: for

PDO staff only.
Load
Composition
Specify the major components of the load carried by the vehicle
Quantity
Specify quantities of major load components carried by the vehicle
Secured by
Indicate which methods and tools were applied to secure the load
Height load
surface
from
road
Give the height in meters of the top of the load with respect to road
surface
Height load bed from road

surface
Give the height in meters of the load bed with respect to the road
surface
Quantity spilled/lost
Specify the quantities of the major components of the load spilled or

lost as a result of the Incident.
Injuries Driver
Tick applicable boxes
Injuries Passengers
Tick applicable boxes
Working Conditions Driver

DAY BEFORE ACCIDENT
Hours worked
Specify number of hours worked and driving (including commuting)
Slept at
Tick the applicable box (place of the last sleep period)
Time of arrival
place/home
Page 54
at
rest
Specify the time at which the driver arrived at his sleeping place after
completing his work
Printed 17/08/08

Number of hours slept
Revision: 2
Effective: Sept 08
Specify number of hours slept by the driver based on his/her statement

DAY OF THE ACCIDENT
Time of departure from

home/rest place
Specify the time the driver left for work.
Hours worked
Specify number of hours worked and driving (including commuting)
Hours driven since last

break
Specify number of hours driven since last break of at least 15 minutes.
Days worked since last full

day without work.
Specify the number of the days since the last full day off from any of the
drivers jobs (he/she may have more than one job)
Days to be worked until

next full day without work.
Specify the number of the days to be worked until next full day off from
any of the drivers jobs (he/she may have more than one job).
Was
the
car
airconditioned at the time of
the Incident.
Specify if the car was equipped with an air conditioner and if it was
switched on at the time of the Incident.
JOURNEY MANAGEMENT SYSTEMS

Estimated
departure
time
of
Specify the estimated time of departure as included on the journey

management form.
Estimated time of arrival
Specify the estimated time of arrival as included on the journey

management form.
Journey approved by
Specify name of the person who signed the journey management form
Action
to
recurrence
Corrective Action items endorsed by the Incident Review Committee

must be listed. Each item must be identified by a number for ease of
follow-up. For each action item a PDO action party must be nominated
by the Committee. Both the current status and the target completion
dates must be recorded.
prevent
Review Committee Comments

This section to be completed by the Secretary of the appropriate Incident Review Committee
following discussion at the meeting.
Heading
Details Required
Date of review
State the date on which the Incident was reviewed by the Incident
Review Committee.
Details adequate
State yes/no. If the report is inadequate it should be rejected and

returned with comments to the relevant Incident Owner.
Comments
State any comments by the review committee on the causes,

circumstances and follow-up of the Incident, and the quality of the
investigation and the report.
Appendix 5:
Page 55
List of Activity at time of Incident
Printed 17/08/08
Revision: 2
Effective: Sept 08
The PDO HSE Incident report form requires the actual activity at the time of the Incident to be noted. This appendix
provides definitions of various activities.
Heading
Description
Using portable tools and

equipment
An Incident as a direct result of the use of hand tools and equipment including but not limited to
the use of all powered or non-powered hand tools, e.g. screwdriver, wrench, shovel, grinder,
chisel, hammer, punch, welding tools, saw, drill, blow torch, hatchet, pliers, scissors, etc.
Manual lifting/handling
An Incident as a direct result of manually moving or rotating an object in any plane or direction.
Operating
machinery
plant
An Incident as a direct result of operating a piece of equipment or machinery (excluding road

traffic Incidents which are reported separately), including but not limited to pumps, compressors,
mixers, well-heads, turbines, heat exchangers, boilers, draw-works, elevators, laboratory
equipment, cranes, vehicle mounted hydraulic hoists, earth moving plant etc.
Handling
materials
hazardous
An Incident as a direct result of hazardous materials whether in solid, liquid or gas form, including
but not limited to acids, alcohol's, arsenic compounds, pesticides, halogen compounds, nitrous
fumes, petroleum products or gas, explosives, chemicals, drugs, medicines, radiation sources,
etc. Check the Toxic Materials Manual for degrees of hazard.
An Incident as a direct result of assembling or dismantling of buildings, plants, process

equipment, pumps, compressors, power generators, instruments, electrical equipment, etc.
Dismantling
assembling
Scaffolding
An Incident as a direct result of the erection, dismantling or use of any type of scaffolding,
including the use of fixed and movable ladders.
Climbing / descending
An Incident as a direct result of climbing on, or descending from, any type of plant, building or
process equipment.
Walking on same level
An Incident as a direct result of any sort of walking (stopping, starting running, jumping) on any
type of horizontal surface: floor, ramp, platform, walkway or street,
Driving / Piloting
An Incident as a direct result of operating mobile equipment such as a car, truck, forklift, crane
(whilst mobile) or piloting any sort of boat, plane or helicopter.
Working at high level
An Incident as a direct result of working at a high (higher than waist) level above the surrounding
grade level or water surface on platforms, columns, vessels, buildings, cranes, scaffolding, etc.
Welding / burning
An Incident as a direct result of any welding, burning or flame cutting operation.
Cleaning
An Incident as a direct result of any sort of internal or external cleaning operations of moving or
stationary equipment, vessels, tanks, buildings, trucks, barges, etc.
Digging
An Incident as a direct result of any kind of earth removal operations, be it onshore or offshore, in
shafts or tunnels, by hand or with machines or explosives.
Sampling
An Incident as a result of a sampling activity of any kind of solid, liquid or gas flow, e.g. feed stock
flows, product flows, utilities system flows, etc.
Draining / flushing
An Incident as a direct result of a draining / flushing operation of any kind of equipment, e.g.
process vessels, tanks / tankers, pipes, bund-wall areas, sewer systems, etc.
Disconnecting
connections
An Incident as a direct result of a part of system, e.g. disconnecting of instrument or electrical

cables or plugs, disconnecting of temporary or permanent pipes or hoses, disconnecting of wire
running tools from wellhead, etc.
Diving
An Incident as a direct result of any operation where people are required to work fully submerged
in water, with or without aqualung, umbilical or submarine hoses, including all surface
operations, e.g. compression and decompression facilities.
Other activity
An Incident not resulting from any of the other mentioned activities, excluding a road traffic
Incidents which is reported on a separate form. In this case the supervisor should state the
Other activity.
Appendix 6:
Page 56
Definitions of Incident Types

Printed 17/08/08
Revision: 2
Effective: Sept 08
The broad Incident types fall into several main categories which are not mutually exclusive. Only one entry per
Incident can be entered, determined by which type of Incident caused the major injury, environmental or financial
impact.
Event
Description
Air Transport
An Incident which happens while transporting people or goods by air (plane, helicopter) and an
Incident of which the major impact is limited to loss of or damage to aircraft and injury and/or
loss of life of crew and passengers. (For example, an aircraft which crashes into a production
station causes loss of containment in a process vessel and subsequently a fire which destroys
the complete facility. This Incident will be classified as a fire and explosion not as air transport).
Assault
An Incident of which the major impact is caused by the direct consequences of an assault on any
person or installation.
Electrical
An Incident of which the major impact is caused by an electrical phenomenon, short circuit, static
electrical discharge, electrocution, etc., and where this impact is limited to the direct
consequences of the electrical phenomenon.
Falls & Trips
An Incident of which the major impact is caused by a fall, trip or slip and where this impact
remained limited to the direct consequences of the fall, trip or slip.
Falling objects
An Incident of which the major impact is caused by a falling object and this impact is limited to
the direct consequences of the falling object.
Fire
explosion
and An Incident of which major impact is a direct result of a fire and/or explosion.
Lifting / Crane An Incident of which the major impact is caused by the direct consequence of lifting or crane
operations
operations.
Loss
Containment
of An Incident of which the major impact is a direct result of loss of containment of a fluid, e.g. oil,
gas, chemical, water, etc. The loss of containment can be due to a leak, rupture, blowout, a
malfunctioning valve, etc.
Pollution
environment
/ An Incident of which the major impact is pollution or any other damage to the environment, e.g.
water, soil, air or plant/animal life.
Road Transport
Any Incident involving a moving vehicle
Theft
Sabotage
a non-HSE Incident, which:
and
- was deliberately initiated for the purpose of secretly taking or damaging property belonging to
someone else with the intention of permanently depriving the owner of its use or possession,
and
- where the most severe impact is the loss or damage of assets, including information assets.
Theft may involve visible intrusion (eg. burglaries) or simply disappearance of an asset.
Unsafe acts
conditions
/ An Incident without any injury, environmental or financial impact, which could, however, have
developed into an Incident with injury, environmental or financial impact because of unsafe acts
or conditions observed or violation of commonly accepted safe procedures.
Water transport
An Incident which happens while transporting goods or people by sea (e.g. boat, barge,) and an
Incident of which the major impact is limited to loss of or damage to the ships/barges and their
cargo and injury and/or loss of life crew and passengers. (For example, a super tanker loses its
cargo of 200,000 bbl oil in coastal waters causing damage to shore and wildlife will be classified
as pollution/environmental).
Other
Any other Incident which can not be categorised within the other broad Incidents type. Including
for example, an illness or adverse health effect caused by recurrent exposure to hazards. The
supervisor should state the "Other" Broad Incident type.
Page 57
Printed 17/08/08

Appendix 7:
Heading
Revision: 2
Effective: Sept 08
List of Immediate Causes
Description
Information error Was an information error or omission occurring between parties directly or indirectly involved
or omission
with the activities leading to the Incident a contributing factor?
Failure to follow Was failure to follow established rules and procedures a contributing factor, e.g. permit-to-work
rules/procedures
system not followed, gas testing or vessel entry procedures not followed, etc.? There are
several reasons why there may be a failure to follow established procedures. These are listed
below :: Procedure not documented. Were there any documented rules or procedures which adequately
covered the task or activity being done when the Incident occurred?
: Procedure considered impractical. Were the rules and procedures covering the task or activity
in place but generally not enforced because they were recognised or considered to be
impractical / inappropriate for the circumstances ?
: Procedure not communicated. Were practical rules and procedures covering the task or
activity in place but they had not been successfully communicated to the people involved in
the Incident? A lack of communication may be due to the persons being unaware of the
procedure or being unable to understand it.
: Other - any other reason not covered above why known rules and procedure were not followed.
Inadequate
warning/safety
devices
Failure
observe
warning
devices
Improper
handling
to Were available warning safety devices ignored, or were necessary warning signals not
use installed, placed or used?
safety
manual Was improper handling e.g. incorrect lifting, carrying, gripping, applying of force a contributory
factor?
Inadequate PPE
Failure
PPE
Were inadequate warning signs, lights, horns, whistles, etc., or malfunctioning warning signals
a contributing factor. Or were safety devices, such a relief valves, blowdown system, level,
pressure, gas or fire detectors, guards, screens or safety nets, by-passed, disconnected,
maladjusted, incorrectly replaced or not installed a contributory factor?
to
Was inadequate quality of required personal protective equipment a contributory factor?
wear Was the failure to wear required PPE equipment a contributory factor?
Influence
intoxicating
substances
of Were the effects, including side effects, of intoxicating liquids or illegal drugs a contributory
factor?
Inadequate
equipment/tools
Were the quality or quantity of the equipment or tools a contributory factor. e.g. non sparking
tools, uninsulated electrical tools, no flame or spark arresters, etc.? Did the equipment or tools
fail during operation?
Misuse
of Was improper use of tools or equipment a contributory factor? Work environment Was
equipment/tools
excessive noise, inadequate ventilation, inadequate illumination, inadequate traffic control,
inadequate building or workshop layout; inadequate furniture, etc. a contributory factor?
Work Environment Was excessive noise, inadequate ventilation, inadequate illumination, inadequate traffic
control, inadequate building or workshop layout, inadequate furniture, etc. a contributing
factor?
Untidy site
Was untidy worksite a contributing factor?
Access
Was inadequate or congested access, aisle space, exits or clearance a contributory factor?
Page 58
Printed 17/08/08
Revision: 2
Effective: Sept 08

External
(third
weather)
factors Were uncontrollable outside influences factors, such as third party drivers, environmental
party, conditions, sabotage, war, weather, floods, landslides, etc., a contributory factor?
Other
State any "Other" Immediate Cause as: Lack of due care and attention; Attack by animal;
Fatigue / Stress; or Lack of safety awareness. If none of these are applicable then specify
applicable immediate cause in words.
Appendix 8:
List of Underlying Causes
Note these Underlying Causes are defined in slightly different terms than the Tripod Beta General
Failure Types. If a Tripod Beta analysis is used then the Tripod Beta GFTs shall be stated.
Heading
Description
Inadequate Physical / Mental Capability
Was some person's lack of physical (eyesight, cripple, hernia,

fitness, etc.) or mental capability or the lack of aptitude for the
job a factor?
Inadequate Knowledge / Skill
Was the lack of knowledge on how to perform the task safely a

factor, or was the lack of skill to do the job safely a factor?
Excessive Stress
Was physical or mental stress a factor in the Incident?
Improper Motivation
Was motivation to perform improper activities or to perform

critical activities a factor? Were any of the persons involved
distracted, reckless or uninterested?
Inadequate Supervision
Was inadequate leadership in direct Line supervision or

inadequate leadership of safety programme activities a factor?
Inadequate
Policy,
Safety
communication thereof.
Plan
or
Was an inadequate formulation of the Policy statement a factor,

or was an inadequate safety plan a factor?
Inadequate Planning and Organisation
Was inadequate job planning or preparation a factor, or was an

inadequate
organisational
structure
(manpower,
communication) a factor?
Inadequate Procedures, Work Standards or

communication thereof
Were inadequate methods, procedures, practices or rules a

factor?
Failure to Observe / Use Warning / Safety

Devices
Were available warning safety devices ignored, or were

necessary warning signals not installed, placed or used?
Inadequate Engineering / Design
Was inadequate design / specification of the facility or of the

process line equipment or of safety devices a factor? Or was
inadequate construction or inspection of construction a factor?
Inadequate Maintenance / Inspection
Was premature failure or malfunction of equipment or

structures a factor? Or was insufficient (or lack of) preventive
maintenance or periodic inspection programme a factor?
Other Underlying Causes
Those which can not be categorised within the abovementioned underlying causes.
Appendix 9:
Page 59
List of Facilities / Plant / Equipment
Printed 17/08/08
Revision: 2
Effective: Sept 08

Type of Facility
Phase of Operation
Material/Product
Process and treatment plants
Construction or erection
Additive
Production facilities
Dismantling
Bitumen
Utilities
Maintenance or repair
Chemical (general)
Product storage (tank farms)
Gas-freeing or cleaning of equipment
Chlorine
Pipe s (off-plot)
Starting up
Crude oil
Transport facilities
Shutting down
Fuel gas
Construction sites
Upset conditions
Fuel oil
Berths/jetties
Normal operation
Gasoline
Movable Field Installations
Others
Natural gas
Loading/unloading facilities
H2S
Buildings
Source of Ignition
Hydrocarbons
Others
Auto or spontaneous ignition
Kerosene
Hot surfaces or equipment
LPG
Equipment Involved
Welding brazing cutting
Residue
Columns
Flares
Steam
Compressors
Open flames
Sulphur dioxide
Furnaces incl. boilers
Smoking
Water
Gas turbines
Lighting
Others
Generators
Static electricity
Heat exchangers
Friction-overheating or impact sparks
Pipework
Smoldering lagging or waste
Leaking Item
Pumps
Gasoline /diesel engine or exhaust
Gasket
Reactors
Electrical equipment
Fitting
Tanks
Collision, vehicles etc.
Flange
Vessels
Sabotage or vandalism
Vent
Others
Chemical reaction
Valve
Plug
Part of Equipment
Iron Sulphide oxidation
Hose
Bellows
Others
Seal
Burners
Pipe
Filter
Unit or Plant
Drain
Flange/gasket
Control building
Nipple
Hose
Offices
Pinhole
Instrument element
Laboratories
Weld
Loading arm
Living quarters/houses
Other
Pump body
Restaurant
Pump seal
Warehouse/yard
Safety relief valve
Workshop/garages
Page 60
Printed 17/08/08

Small bore piping
Steam/Hot water injection
Valve-
Firewater system
Others
Flow line-gas \ oil
Revision: 2
Effective: Sept 08
Gas Compression
Gas Treatment
Gathering Station
LPG Facilities
Oil Separation
Oil storage
Offshore mooring
Pipeline Gas \ Oil \ other
Pumping \Booster Station
Station \ metering
Tanker- sea
Tanker Loading
Well Head/Drilling facilities
Wireline/workover unit
Others
Appendix 10: List of Injury / Occupational Illness

(Note: Only one entry is permissible)
Heading
Description
Nature of injury
The nature of injury classification identifies the injury in terms of its principal physical
characteristics.
General rule
Name the basic injury rather than its sequel.
Rules for selection in When one injury is obviously more severe than any of others, select that injury. For
cases of multiples injures example select an injury involving permanent in preference to temporary injury.
When there are several injuries of different natures, such as cuts and sprains, no one is
indicated as being more serious than the others, classify as multiple injuries.
Damage of eyeglasses, hearing aids, dentures or artificial body parts is not considered
an injury.
Open wounds
e.g. cuts, lacerations, punctures, foreign objects (splinter).
Crushing/contusions/brui
ses
Intact skin surface.
Bites and stings
All bites and stings (insect, dog, human, reptile, etc.) except venomous reptile and insect
bites, see poisoning.
Superficial injuries
e.g. scratches, abrasions.
Burns (heat/cold)
The effect of contact with hot or cold substances. Include electric burns, but not electric
shock. Does not include chemical burns, effects of radiation, sunburn, systematic
disability such as heat stroke, friction burns, etc.
Page 61
Printed 17/08/08

Burns (chemical)
Revision: 2
Effective: Sept 08
Tissue damage resulting from the corrosive action of chemicals, chemical compounds,
fumes etc. (e.g. acids, alkalis).
Heat
stroke/sun All effects of exposure to environmental heat. Does not include sunburn or other effects
stroke/heat exhaustion
of radiation.
Radiation effects
Sunburn and all forms of damage to tissue, bones or body fluids produced by exposure to
radiation (e.g. sun light, X-ray, gamma ray, etc.).
Asphyxia, strangulation
Respiratory problems caused by oxygen deficiency or by airway obstruction. Does not

include drowning or the effects of toxic agents.
Fractures
A break or rupture in a bone.
Cerebral Concussion
Transient loss of consciousness for a few seconds followed by a retrograde and posttraumatic amnesia
Cerebral Contusion
Loss of consciousness longer than cerebral concussion often followed by a severe

residual neurologic deficit.
Dislocation
Displacement of a bone end at a joint
Drowning
Aspiration of fluids which results directly in asphyxia.
Sprains and strains
A sprain is an injury with stretched or torn ligaments, soft tissue damage around the joint.
A strain is a muscle injury from over stretching.
Hernia/rupture
Includes both inguinal and non-inguinal hernia, and all internal injuries.
Drowning
Loss of sight
Hearing
impairment
Loss of sight or impairment of sight.

loss
or Hearing loss / impairment as a separate, single injury not the sequel of another injury.
Poisoning
A systematic morbid condition resulting from the inhalation, ingestion, or skin absorption
of toxic substance affecting the functioning of the metabolic system, the nervous system,
the circulatory system, the digestive system, the respiratory system, the excretory
system, the musculo-skeletal system, etc. Includes chemical or drug poisoning, metal
poisoning, organic diseases, and venomous reptile and insect bites. Does not include
effects of radiation, pneumoconiosis (dust disease), corrosive effects of chemicals; skin
surface irritations; septicemia or infected wounds.
Other injury
All injuries not elsewhere identified (state ).
Multiple injuries
Several injuries of different natures, such as cuts and sprains, no one of which is
indicated as being more serious than the others.
Electrical shock
Shock from contact with an electrical source. Excludes electric burns.
Nature of Occupational Illness

Occupational illness exclude all illness caused by a single event or a number of events close together in the
course of employment. Only one entry is allowed.
Heading
Description
Noise Induced Hearing Loss
Hearing loss from long-term exposure to high noise levels.
Lung problems/diseases
e.g. occupational asthma, dust disease (pneumoconiosis) such as silicosis or

asbestosis.
Skin disease
e.g. contact dermatitis from repeated skin contact with solvents or allergic eczema
from repeated contact with epoxy resins.
Page 62
Printed 17/08/08
Revision: 2
Effective: Sept 08
Poisoning
Systemic affects due to toxic mass e.g. anemia from repeated benzene exposure.
Physical causes
e.g. radiation, excluding effects from a single event, diseases from long-term
exposure to vibration. (Excludes Noise Induced Hearing Loss and toxic materials).
Infections/contagious
e.g. tropical infections or contagious disease contracted during the course of

employment, animal disease, tuberculosis.
Cancer
e.g. mesothelioma from asbestos exposure.
Stress
Disorders due to stress at work
Repetitious Injury
Disorders associated with repeated minor trauma.
Other occupational illness

(state).
Any illness not listed above - specify details
Classification of Occupational Illness

1
Infectious and Parasitic Diseases: malaria, food poisoning, infectious hepatitis, dysentery, lambliasis,
legionnaire's disease.
2
Skin Diseases and Disorders: contact dermatitis, allergic dermatitis, rash caused by primary irritants and
sensitisers or poisonous plants, oil acne, chrome ulcers, chemical burns or inflammations.
3
Respiratory Conditions due to Dust or Toxic Agents: silicosis, asbestosis, pneumoconiosis, pneumonitis,
(allergic) bronchitis, alveolitis, asthma, pharyngitis, rhinitis or acute congestion due to chemicals, dusts, gases, or
fumes.
4
Poisoning (Systemic Effects of Toxic Materials): poisoning by lead, mercury, arsenic, cadmium, or other
metals; poisoning by carbon monoxide, hydrogen sulphide, or other gases; poisoning by solvents; poisoning by
pesticides; poisoning by other chemicals such as formaldehyde, plastics and resins.
5
Disorders due To Physical Agents (Other than Noise and Toxic Materials)Examples: heat-stroke, sunstroke,
heat exhaustion and other effects of heat stress; freezing, frostbite and other effects of exposure to low temperatures;
caisson disease; effects of ionising (alpha, beta and gamma rays, radium) and non-ionising (welding flash, ultraviolet
rays, microwaves, sunburn) radiation
6
Disorders associated with Repeated Trauma: synovitis, tenosynovitis, and bursitis; Raynaud's phenomenon;
other disorders of the musculo-skeletal system and connective tissue associated with repeated trauma.
7
Cancers and Malignant Blood Diseases: mesothelioma; bladder cancer; leukaemia and other malignant
diseases of blood and blood forming organs
8
Disorders due to Mental Stress: tension headache, depression, neurosis, "stress", functional disorders of the
gastrointestinal tract
9
Noise Induced Hearing Loss: definition and criteria for reporting are given in the SHC Noise Guide
1991.
10
Other Illness and Disorders: Benign tumours; eye conditions due to dust and toxic agents; other
(non-malignant) diseases of blood and blood forming organs.
Appendix 11:
11.1
Examples Determining Environmental Incident Risk Potential

Incidental Releases of Solids or Liquids to Soil or Water
The Environmental Incident Severity Rating Index (EISRI) has been developed to give a quantitative
assessment of the potential of a solid or liquid released to soil or water to damage the environment.
There are three main factors which determine the potential for a particular environmental Incident to
impact the environment:
Sensitivity Index (S) - the sensitivity of the receiving environment into which the material is released
which depends upon various factors:
Page 63
Proximity to people either as local residents, workers in a work location or temporary

accommodation, or travelling;
Printed 17/08/08
Revision: 2
Effective: Sept 08
proximity to "domestic" (i.e. herded or grazing) animals or agriculture;
Proximity to native (i.e. wild) fauna and flora, and their types;
Proximity and ease of access to surface water and potable aquifers;
Local topography, land use and land/soil quality.
These factors have been summarised and a Sensitivity Index (S) allocated as shown in the table
below.
Table Appendix-11.1-Sensitivity Index
Description of Receiving Environment
Sensitivity Index (S)
Flat topography (no vegetation, no population)
Sloping topography (no vegetation, no

population)
Proximity to aquifer for use other than drinking

water
10
Marine (sea) environment
100
Agricultural land, populated
100
Proximity to potable aquifer
100
Wadi
100
Within a Nature Reserve
100
Toxicity Index (T) - a measure of the toxicity of the material (solid or liquid) released into the
environment. The Toxicity Index for several materials commonly used in PDO's operations is given in
Table Append-11.2. or can be obtained from the corresponding SHOC card of the chemical concerned
Quantity (Q) - the amount of material released expressed in cubic metres.
Note that all spills or leaks are reportable (within the general rules found in Section 11.1) no matter how
small the quantity is.
The EISRI is calculated as follows:
EISRI =
(S x T x Q) = S x T x Q 1,000
1000
The calculated EISRI value is then entered into Table Append-11.3 to determine the actual
environmental impact and severity rating.
The potential environmental risk depends on the potential severity and the probability of the Incident
happening again. Potential severity is determined by recalculating the value of EISRI based on
potential scenarios and using Table Append-11.3. Once the potential severity has been determined,
the probability of the Incident happening again must be assessed. Both are then entered into the RAM
to determine the overall potential HSE risk.
Table Append-11.2 Toxicity Index of Common Hazards
Common Hazards Discharged in an

Environmental Incident
Page 64
Waste Management Chart Number

(Part D of the Waste Management
Manual)
Toxicity
Index
Printed 17/08/08
Revision: 2
Effective: Sept 08

Acid spent
A001
1,000
API sludge
O003
1,000
Asbestos
A004
1,000
Battery acid
B004
1,000
Chemical waste
C005
10,000
Clinical waste
C006
1,000
Crude oil
Refer to L001
1,000
Cuttings (oil base mud)
C007
1,000
Cuttings (water base mud)
C008
10
Degreasing solvents (halogens)
D001
1,000
Dehydration water
P007
10
Drilling fluid (oil based)
O001
1,000
Drilling fluid (brine)
B005
10
Engine oil (spent)
L001
1,000
Ferric sulphide (pyrophoric dust)
P008
10,000
Low Specific Activity Scale (or NORM))
N001
10,000
Lubricants (spent)
L001
1,000
Paint
P002
100
Paint thinner
T002
100
Pigging wastes
P004
100
Sewage (untreated)
S001
100
Table Append-11.3 Severity Rating and Qualitative Environmental Impact
Calculated EISRI
0
Severity Rating
No Effect
< 50
Slight Effect
50 - 4,999
Minor Effect
Localised Effect
5,000 - 49,999
Page 65
Environmental
Impact
Printed 17/08/08
Revision: 2
Effective: Sept 08

50,000 - 499,999
> 500,000
11.2
Major Effect
Massive Effect
Other Environmental Incident Types
Some environmental Incidents can not easily be classified according to quantity, toxicity and sensitivity
of the receiving environment and hence the EISRI can not be determined quantitatively. Examples of
these Incidents types include animals (camels, desert fox, rabbits, etc) falling into waste pits, releases
of natural gas, Halons or CFCs, presence of objectionable smells or high noise levels, and third party
environmental complaints, etc. For these types of environmental Incidents, a qualitative approach for
determining the environmental impact must be used as defined in Table Appen-11.4. Table Append-2.4
contains a qualitative description of each environmental impact and corresponding severity rating.
11.3
Examples Of Environmental Incident Risk Assessment
11.3.1 Oil spill

Example 1
Consider a spill of 1 m3 of oil from a flow line in flat, unpopulated terrain. As the Incident is a spill of
liquid an EISRI can be calculated. Using Table Append-11.1, the Sensitivity Index (S) for flat
unpopulated terrain is 1. Using Table Append-11.2, the Toxicity Index (T) for oil is 1,000. The quantity
(Q) of oil released is 1 m3.
Therefore the EISRI = S x T x Q/1000 = 1 x 1,000 x 1/1000 = 1. Using Table Appendix-11.3, the
actual consequence of the Incident is a Slight environmental impact with a severity rating of 1. An
actual severity of 1 indicates that investigation may be delegated to the level of Company Site
Representative.
In calculating the Potential Consequence of the Incident it is necessary to review what could potentially
have happened to increase the severity of the Incident. For example, consider whether the flow line
runs through a wadi anywhere along its length. In this case the Sensitivity Index would increase to 100
and the EISRI to 100. Using Table Appendix-11.3, the Potential Consequence of the Incident becomes
Minor environmental impact with a severity rating of 2. Also consider whether the volume of oil spilled
could have been larger. For example the leak could have started just before nightfall and would not be
noticed until the morning, increasing the volume to 100 m3. This could further increase the EISRI to
10,000. Using Table Appendix-11.3, the Potential Consequence of the Incident becomes Localised
environmental impact with a severity rating of 3. If the probability of the Incident happening again is
determined to be 'D' (i.e. happens more than 5 times a year in PDO), the potential HSE risk in RAM is
3D and the Incident is classified as Medium Potential.
Example 2
Consider a 5 m3 crude oil leak into the sea while loading at the SBM. As the Incident is a spill of liquid
an EISRI can be calculated. Using Table Appendix-11.1, the Sensitivity Index (S) for the sea is 100.
Using Table Appendix-11.2, the Toxicity Index (T) for oil is 1,000. The quantity (Q) of oil released is 5
m3.
Therefore the EISRI = S x T x Q/1000 = 100 x 1,000 x5/1000 = 500. Using Table Appendix-11.3, the
actual consequence of the Incident is a Minor Environmental Impact with a severity rating of 2. An
actual severity of 2 indicates that investigation may be delegated to the level of Company
Representative.
have happened to increase the severity of the Incident. For example, consider whether the volume of
oil spilled could have been larger. For example 50 m3 of oil could have been spilled before action was
taken to stop the flow. This would increase the EISRI to 5,000. Using Table Appendix-2.3, the
Potential Consequence of the Incident becomes Localised environmental impact with a severity rating
of 3. If the probability of the Incident happening again is determined to be 'D' (i.e. happens more than
5 times a year in PDO), the potential HSE risk in Fig. RAM is 3D and the Incident is classified as
Medium Potential.
Page 66
Printed 17/08/08
Revision: 2
Effective: Sept 08
Alternatively, if the potential quantity spilled is 500 m3, the EISRI would increase to 50,000. Using
Table Appendix-2.3, the Potential Consequence of the Incident becomes Major environmental impact
with a severity rating of 4. If the probability of the Incident happening again is determined to be 'D' (i.e.
happens more than 5 times a year in PDO), the potential HSE risk in RAM is 4D and the Incident is
classified as High Potential. Using Fig. G4 the ownership level is Line Director.
11.3.2 Natural Gas Leak
Consider a 2 scm gas leak from a flow line. As the Incident does not involve a spill of liquid or solid
material, a qualitative approach for determining environmental impact must be used. Using the
qualitative description of Environmental Impact of an Incident in Table Appendix-11.4, the actual
consequence of the Incident is a Slight environmental impact with a severity of 1 since the quantity of
natural gas released is less than 1,000 scm. An actual severity of 1 indicates that investigation may be
delegated to the level of Company Site Representative.
have happened to increase the severity of the Incident. For example, consider whether the leak could
have gone undetected for longer resulting in a larger volume of gas, say 1,500 scm, being released. In
this case, using Table Appendix-11.4, the Potential Consequence of the Incident becomes Minor
environmental impact with a severity rating of 2. If the probability of the Incident happening again is
determined to be 'D' (i.e. happens more than 5 times a year in PDO), the potential HSE risk in RAM is
2D and the Incident is classified as Medium Potential.
11.3.3 Halon Release
Consider a release of 75 kg of Halon. As the Incident does not involve a spill of liquid or solid material,
a qualitative approach for determining environmental impact must be used. Using the qualitative
description of Environmental Impact of an Incident in Table Appendix-11.4, the actual consequence of
the Incident is a Minor environmental impact with a severity rating of 2 since the quantity of Halon
released lies between 50 and 100 kg. An actual severity of 2 indicates that investigation may be
delegated to the level of Company Representative.
have happened to increase the severity of the Incident. Usually if the fire fighting system is triggered,
all the Halon contained in the system is released at once and there is no potential for the amount
released to be increased. In the unlikely event, for example, of only half the total quantity of Halon
being released, the quantity could increase to 150 kg. In this case, using Table Appendix-11.4, the
Potential Consequence of the Incident becomes Localised environmental impact with a severity rating
of 3. If the probability of the Incident happening again is determined to be 'D' (i.e. Halon releases
occur more than 5 times a year in PDO), the potential HSE risk in RAM is 3D and the Incident is
classified as Medium Potential.
11.3.4
Untreated Sewage Release
Consider a spill of 20 m3 of untreated sewage from a tanker on the road between a seismic camp and
a sewage treatment plant. As the Incident is a spill of liquid an EISRI can be calculated. The road is
running through flat, unpopulated terrain. Using Table Appendix-11.1, the Sensitivity Index (S) for flat
unpopulated terrain is 1. Using Table Appendix-11.2, the Toxicity Index (T) for untreated sewage is
100. The quantity (Q) of sewage released is 20 m3.
Therefore the EISRI = S x T x Q/1000 = 1 x 100 x20/1000 = 2. Using Table Appendix-11.3, the actual
consequence of the Incident is a Slight Environmental Impact with a severity rating of 1. An actual
severity of 1 indicates that investigation may be delegated to the level of Company Site
Representative.
Page 67
Printed 17/08/08
Revision: 2
Effective: Sept 08
have happened to increase the severity of the Incident. For example, consider whether the road runs
through a populated area anywhere along its length. In this case the Sensitivity Index would increase
to 100 and the EISRI to 200. Using Table Appendix-11.3, the Potential Consequence of the Incident
becomes Minor environmental impact with a severity rating of 2. If the probability of the Incident
happening again is determined to be 'C' (i.e. Incident has occurred in PDO), the potential HSE risk in
RAM is 2C and the Incident is classified as Low Potential.
11.3.5 Dead Wildlife in Drilling Waste Pit
Consider a camel found dead in a drilling waste pit with complaints or claims received from the public.
As the Incident does not involve a spill of liquid or solid material, a qualitative approach for
determining environmental impact must be used. Using the qualitative description of environmental
impact of an Incident in Table Appendix-11.4, the actual consequence of the Incident is a Minor
environmental impact with a severity rating of 3. An actual severity of 3 indicates that investigation
may be delegated to the level of Section Head.
In this example, it is difficult to predict a situation where the Potential Consequence of the Incident is
higher than the Actual Consequence and therefore the Potential Consequence equals the Actual
Consequence. If the probability of the Incident happening again is determined to be 'C' (i.e. Incident
has occurred in PDO), the potential HSE risk in RAM is 3C and the Incident is classified as Medium
Potential.
11.3.6 Persistent Complaints from Third Parties
Consider a number of complaints being received from third parties owing to odours from a sewage
treatment plant. As the Incident does not involve a spill of liquid or solid material, a qualitative
approach for determining environmental impact must be used. Using the qualitative description of
Potential Consequence of an Incident in Table Appendix-11.4, the actual consequence of the Incident is
a Localised environmental impact with a severity rating of 3. An actual severity of 3 indicates that
investigation may be delegated to the level of Section Head.
Consequence. If the probability of the Incident happening again is determined to be 'E' (i.e. complaints
are made more than 5 times a year for the particular location), the potential HSE risk in RAM is 3E and
the Incident is classified as High Potential.
11.7 Persistent Cases of ExceedingEnvironmental Permit Requirements
Consider a sewage treatment plant where more than three consecutive weekly analytical results
indicate that the total coliform count is > 1600 (MPN/100ml). Since the permit requirement is 1,000
(MPN/100ml), this is a regular case of exceeding the limits. As the Incident does not involve a spill of
liquid or solid material, a qualitative approach for determining environmental impact must be used.
Using the qualitative description of Potential Consequence of an Incident in Table Appendix-11.4, the
actual consequence of the Incident is a Localised Environmental Impact with a severity rating of 3. An
actual severity of 3 indicates that investigation may be delegated to the level of Section Head.
Consequence. If the probability of the Incident happening again is determined to be 'E' (i.e. exceeding
permit requirements occurs more than 5 times a year at the particular location), the potential HSE risk
in RAM is 3E and the Incident is classified as High Potential. Incident ownership level is Line Director.
Table Appendix 11.4 Potential Environmental Impact
Page 68
Printed 17/08/08
Revision: 2
Effective: Sept 08
Severity Environmental Description

Rating
Impact
1.
Slight Effect
An adverse effect on any attribute1 of the environment is observable or

measurable above background, is of short duration, confined to the
Company site and no complaints from third parties or governmental concern.
Halon and CFC release < 50 kg. Gas leak < 1,000 scm. Remedial action
cost less than US$ 1,000. EISRI < 50.
Examples:
2.
Minor Effect
Small oil/water spill from flow line confined to soil surface and
disappears after evaporation.
Wild or domestic animal found in waste pit and rehabilitated.
Adverse effect is likely to be detected by third parties but does not exceed a
recognised standard of environmental quality. Effect does not impair the use
of the environment for other users. Single case of exceeding permit
requirement or internally prescribed standard. Halon and CFC release 50 100 kg. Gas leak of 1,000 scm and greater. Investigation, monitoring or
clean-up cost US$ 1,000 - 10,000. EISRI 50 - 4,999.
Examples:
Oil/water spill from flow line which seeps into the sand.
Gas or exhaust release causing temporary smoke or smell.
Improperly disposed non-hazardous waste which is readily collected.
Wild or domestic animal found dead in waste pit.
Visual quality; Chemical quality (air, soil, water, living resources); Biological quality (diversity); Noise level; Smell
Page 69
Printed 17/08/08
Revision: 2
Effective: Sept 08
Severity Environmental Description

Rating
Impact
3.
Localised
Effect
Environmental quality in the vicinity of operations becomes substandard or

unfit over a limited area for one or more purposes including supporting
normal wildlife population; interference with other users causes loss of
earnings, complaints or claims. Repeated cases of exceeding permit
requirement or internally prescribed standard. Halon and CFC release > 100
kg Remedial action cost US$ 10,000 - 100,000. EISRI 5,000 - 49,999.
Examples:
4.
Major Effect
Oil spill from flow line which seeps into sand or from pipeline requiring
significant excavation.
Localised contamination of 3rd party land or soil by oil, spilled chemical

or waste, preventing use of an individual source of potable water or
piece of land.
Physical damage which results in loss of livestock or interference with

overland travel.
Repeated occurrence of objectionable smells which result in complaints

from 3rd parties.
Improper disposal of hazardous waste requiring identification, analysis

and site clean up.
Excessive oil levels in permitted MAF tank farm discharge or oily sheen
observed.
Small oil spill at MAF tanker loading operation which has to be cleaned
up from sea.
Physical damage to natural features (ecological, heritage, surface

geology).
Significant deviation from environmental permit (e.g. sewage treatment

effluent quality).
A number of wild animals found dead in waste pit.
A radioactive source lost subsurface.
Environmental damage is widespread and detectable for some distance

beyond operational area. Large scale effort is required to restore the
environment to a satisfactory condition. Clean-up and site restoration costs
US$ 100,000 - 1,000,000. EISRI 50,000 - 499,999.
Examples:
Page 70
Oil spill at MAF tanker loading operation which arrives on local beaches
requiring onshore and or offshore clean up operations.
Any physical damage caused to nature reserve area for rare species.
Localised contamination of a ground water resource making it unfit for

human consumption or irrigation.
Printed 17/08/08

5.
Revision: 2
Effective: Sept 08
Massive Effect Extensive damage to attribute(s) of natural environment thereby affecting its
ability to support human population or wildlife. Prolonged recovery period
(several years) or site cannot be restored to satisfaction of interested parties.
Clean-up and site restoration costs > US$ 1,000,000. EISRI > 500,000.
Examples:
Page 71
Maximum credible release of PDO crude oil from MAF facilities such
that oil is dispersed along several kilometres of beaches affecting
recreational, fishing interests and water abstraction.
Widespread severe contamination of ground water resource making it

unfit for human consumption or irrigation.
Any damage which affects the numbers of a rare species.
Printed 17/08/08

GU-612 - Guidelines - Incident Investigation and Reporting

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

GU-612 - Guidelines - Incident Investigation and Reporting

Uploaded by

Copyright:

Available Formats

Petroleum Development Oman L.L.C.

Document ID: GU-612

[Health Safety Environment & SD]

This page was intentionally left blank

Authorised For Issue

Ref. Ind: MSE/5

Updated in line with the Yellow Guide issue Dec

Updated in line with new SIEP Standard for Health,

Update Procedure to bring it into line with FIM Incident

Supersedes HSE/97/01, Rev.3. Ratification of

Sherban, Aligned with asset Management organisation

Sherban, Second printing with revisions

Sherban, Supersedes SRD/P/01, Rev.2. Reflects changes in

iii Related Business Processes

Business Process (EPBM 4.0)

iv Related Corporate Management Frame Work (CMF) Documents

Related Business Processes........................................................................................................................ 5

Related Corporate Management Frame Work (CMF) Documents...............................................................5

Incident Investigation & Analysis............................................................................................................ 9

The Initial Investigation (immediate).................................................................................................. 9

The Full Investigation........................................................................................................................ 10

Organization and ToR for PDO Incident Review Committees........................................................24

MD Incident Review Panel (MDIR)................................................................................................... 24

Directorate Incident Review Committees (IRCs).............................................................................26

Definitions and Explanation of Terms.............................................................................................. 28

INCIDENT REPORT TEMPLATES...................................................................................................... 36

High Potential Incident Reports......................................................................................36

Non-accidental Death Reports......................................................................................... 38

General Medium Potential Incident Report....................................................................39

Medium Potential Road Traffic Accident Report............................................................48

List of Activity at time of Incident....................................................................................59

Definitions of Incident Types........................................................................................... 61

List of Immediate Causes................................................................................................. 62

List of Underlying Causes................................................................................................ 63

List of Facilities / Plant / Equipment..............................................................................64

List of Injury / Occupational Illness................................................................................65

Examples Determining Environmental Incident Risk Potential..................................68

Incident Investigation & Analysis

To identify the direct, contributing and root cause(s) of an Incident

Initial investigation / information preservation

The Initial Investigation (immediate)

Petroleum Development Oman LLC

The Full Investigation

Determination of Investigation Level and Team Composition

Table 3 - Investigation Team Suggested Make-up

Suggested Minimum Investigation Team

Section Head, PDO Responsible Supervisor,

Department Head or Area Team Leader, Contract

Director, Department Manager, Contractor CEO /

Incident Investigation, Analysis and Reporting Guideline

Petroleum Development Oman LLC

Background is required on the following for most Incidents:

Location plans and road maps etc.

1.3.4 The Investigation Process

Incident Investigation, Analysis and Reporting Guideline

Petroleum Development Oman LLC

You have to find out as

Name, age, service with the company

Record the serial numbers/number plates of all of the

Incident Investigation, Analysis and Reporting Guideline

Petroleum Development Oman LLC

that it was available to the employee

The environment can have

Will change very little over time.