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Motor Vehicle Accident Report

State Final
Version V1.0
Civil CSM-WSSM I-2 Incident Reporting and Investigation
Issue Date 6/26/2016
REPORT ACCIDENT TO SAPMT REPRESENTATIVE WITHIN ONE HOUR BY FAX OR PHONE AND WITHIN 24 HOURS, FAX PRELIMINARY ACCIDENT REPORT AND WITHIN 48 HOURS,
DELIVER COMPLETED MVA REPORT TO SAPMT OFFICE.

Date of Accident:* 2/7/2017 Time of Accident:* 7:30 AM Job No. or BI No.:* 10-01382-007

Contractor Name: * Arabtec Construction Contract Number: * 6600034607

Driver V1- Company Name:* EFECO Driver V2- Company Name: EFECO

VehicleType:* V1 V2
Name Driver 1:* Mr.Imran Mohammed ID Number:* No. 2315701983
Name Driver 2: Mr.Bander Diafallah ID Number: No. 1053714281
Witness #1: No Witnesses Telephone / Mobile No:
Witness #2: No Witnesses Telephone / Mobile No:
V1 Cost of Damage:* V2 Cost of Damage
V1 Description of Damage: Damage to right rear end of car V2 Description of Damage: Damage to front and rear end of car

V1 Driver Permit: V2 Driver Permit: MVA Type:

Basic Cause of the MVA

Vehicle # 1 Vehicle # 2
Basic Vehicle Movement
Vehicle # 1 Vehicle # 2
Incident Narrative: On dated 2nd July 2017, at around 07:30 am, Mr. Imran Mohammed while taking a left U turn from the main
road between gate No:1 and Gate No:2 (driving his Toyota Corolla car- 1324 NZJ), was hit from behind by another same model
car (4384 VKA) driven by Mr Bander Diafallah. It was clear from investigation that the Incident occurred as result of both drivers
reckless driving. Mr. Imaran Mohammed taken a U-turn on the road where there are no designated traffic signs appeared to make
a U-turn and slow down the car on main track. The same moment Mr. Bander Diafallah was driven his car on excessive speed on
same track at the behind and which resulted Mr Bander Diafallah car smashed on the right rear side of Mr. Imran Mohammed car
and damaged both parties vehicle (including the right rear end of Mr. Imran Mohammed car and front and back bumper of Mr.
Bander Diafallah's car). No one was injured in this MVA.

Vehicle Information
Vehicle # 1 Vehicle # 2
Manufacturer Toyota Manufacturer Toyota
Color Blue Color Blue
Plate Number 1324 NZJ Plate Number 4384 VKA

Root Cause Analysis:*

Track the main root cause of the accident. Select the most significant factors.
Use Additional Pages as required.
Personal Factors Job Factors

*See attached accident photos

Corrective Actions:

* Incident Investigation meeting conducted to find and address root causes.

*The involved employees ( Mr.Imran Mohammed & Mr.Bander Diafallah) will be restricted to drive the car to relax and release the
stress of the incident, atleast for a two weeks period (ie; until 16th of July-2017) based on the recommendation of Aramco Safety
Coordinator.
* The refresher training on the matter of "Inhouse traffic rules and regulations" will be conducted for employees who are handling
vehicle's in the project premises.
* The recomendation of providing horizontal physical barriers between the two way track to avoid any improper U-turn practice,
will be suggest to SAMPT.
* The Incident scenario and investigation recomendations will be communicated with employees for the subject awareness.

Disruption to Contractor Operations: Major Injuries:

If Yes give details: N/A If Yes give details: N/A
Damage to Contractor Property: Fatality:
If Yes give details: N/A If Yes give details: N/A
Contractor Representative:

Mr Fadi Al Bashir (PM)

Name and Signature Date
cc: Company Representative