ECONOMIC ZONES COMPANY (MANATEQ)

PROJECTS DEPARTMENT
(HSEMS)

HSE INCIDENT INVESTIGATION REPORT (HSE-I

Part A - Incident Information (from the incident notification form
Project Title: QEZ 1 Document ref.:
Contractor: Sacyr UCC JV Contract No.: CW02 Package:
PMCM: Dorsch Consultant : Dorsch
Date: 29-10-2018 Location: Parcel A: LIFTING STATION
Fatality (LTI)*1 Major Injury (LTI) Over 3 days Inj
Incident type: Occupational Disease (LTI) Dangerous Occurrence Environmental
Time of Incident: When reported: 29-10-2018 . 07.05PM
Name Position Company
Reported by: SAMSON HENRY HSEO Sacyr UCC JV
Supervisor: Mr Nishan Singh Foreman Sacyr UCC JV
Investigation team details:
Name Position Company
Team Leader Wayne Tyson HSE Manager Sacyr UCC JV
Member SAMSON HENRY HSEO Sacyr UCC JV
Member Loveson Glariayns Senior HSE Engineer Sacyr UCC JV
Description of the Incident (Describe in detail what happened, refer to attached supporting data i.e. witness statement, compa
etc.):
On 29th October 2018 , 07:05 PM at lifting station Mr. MD Majad(QID 28005018136) a labor was tasked to lift up the tower lig
light using lifting handles, but was unaware of a pinch point created between the wire rope and lamp post behind – his finger was
causing a crushing injury to the right small pinky finger, amputating the tip of the finger.

Immediate actions taken after the incident (correction/remedial action):

Immediately IP was taken to JV site clinic by Site Engineer and basic first aid was given by site nurse later site nurse called amb
assistance. Without further delay ambulance and police came, IP was transported to HMC Wakra hospital for further treatment. S

Events leading up to the incident:

PARCEL A - LIFTING STATION, Mr.MD Majad (IP) was helping to relocate the tower light from generator room to another locatio
was placed inside the generator room horizontally. To retract the boom it need to keep tower light vertically for that foremen and
to push the tower light outside. At that time IP was holding the hand in between wire rope and pulley, This time the wire rope was
pushed the tower light to move the wire rope gets tightened and IP’s finger was caught in this pinch point, causing a crushing inju
finger, amputating the tip of the finger.

Environmental Conditions:
Illumination/ visibility (Dark, dusk, adequate, glare, blinding):

Temperature
Wind Speed (if
o
)
(Capplicable) 26 Humidity (%) 9
3 knots Other (specify)
Equipment used/Involved in the incident:
Tower Light
Procedure/Reports:

MNTQ-HSE-FRM-05 Rev. 1.0 Issue Date: 16/04/2017 Page 1/10

TIGATION REPORT (HSE-IIR)
n (from the incident notification form)
EZ01-CW02-UCSA-HSE-
Document ref.: INR-0015
Package: DTS
Dorsch
Parcel A: LIFTING STATION
Over 3 days Injury (LTI)
Environmental Moderate/Major
29-10-2018 . 07.05PM
Contact No
33572904
30425302

Contact No
33523114
33572904
33078641
attached supporting data i.e. witness statement, company procedure, photographs,

005018136) a labor was tasked to lift up the tower light manually .He raised the tower
en the wire rope and lamp post behind – his finger was caught in this pinch point,
of the finger.

aid was given by site nurse later site nurse called ambulance to have medical
nsported to HMC Wakra hospital for further treatment. Still waiting for medical report.

e the tower light from generator room to another location, Fully extended tower light
eed to keep tower light vertically for that foremen and a two helper along with IP tried
ween wire rope and pulley, This time the wire rope was loose and when the workers
r was caught in this pinch point, causing a crushing injury to the right small pinky

MNTQ-HSE-FRM-05 Rev. 1.0 Issue Date: 16/04/2017 Page 2/10

 ECONOMIC ZONES COMPANY (MANATEQ)
PROJECTS DEPARTMENT
(HSEMS)

HSE INCIDENT INVESTIGATION REPORT (HSE-I

Tool Box Talk details:
Attached
Risk Assessment Method Statement/ Job Hazard Analysis (RAMS/JHA) details:
Attached
Induction/Training (including third party details):
Attached
Reports Initial Police Initial Medical Other (specify)
Witness details Name Position Company
1 Nishan Singh Foreman JV
2 Surendar Singh Labor JV
Injured Person's (IP) Personal Details:
Name MD Majad Occupation: Labor ID No:
Gender (Male/Female): Male DoB and Age: 1/1/1980 Nationality
Next of kin Contact no
Employer AL HAZAM Length of service 25/09/2018
IP sent to hospital: If Yes, Name of the hospital and contact no Hamad Hospital Wakra 40114444
IP was accompanied by (name and contact no)
IP had basic PPE? Yes/No: IP had job specific PPE? Yes/No
Part B - Incident Investigation Details
Injury Details
Nature of Injury/Illness:
Amputation

Mechanism of Injury/ Illness:

Struck by moving object

MNTQ-HSE-FRM-05 Rev. 1.0 Issue Date: 16/04/2017 Page 3/10

TIGATION REPORT (HSE-IIR)

etails:

Other (specify)
Contact No
30425302
70449166

28005018136
Bangladesh

nt Investigation Details

MNTQ-HSE-FRM-05 Rev. 1.0 Issue Date: 16/04/2017 Page 4/10

 ECONOMIC ZONES COMPANY (MANATEQ)
PROJECTS DEPARTMENT
(HSEMS)

HSE INCIDENT INVESTIGATION REPORT (HSE-I

Source of Injury/Illness:

Manual Handling and Ergonomics

Body Parts:
Upper Extremity

Incident Cause analysis

1) Immediate Causes
Unsafe Act:
1. Following Procedures 1.5 Improper position or posture for the task Other

Unsafe Condition:
4. Inattention / Lack of Awareness 4.1 Improper decision making or lack of judgment

2) Root Causes:

Personal Factors
6.Skill Level 6.1 Inadequate assessment of required skills Other

Job Factors
8.Management /Supervision / Empl8.3 Inadequate correction of prior hazard / incident 11.3.3 Inadequate examination
15.Communication 11.1 Inadequate work planning

Investigation Conclusions:
REPORT ATTACHED

Corrective actions to prevent the recurrence:

REPORT ATTACHED

RAMS*2 Permit To Work Photos

✘ ✘

Attachments Final Police Report Final medical report MSDS/COSHH*3

✘ Incident notification form Other (specify)

MNTQ-HSE-FRM-05 Rev. 1.0 Issue Date: 16/04/2017 Page 5/10

TIGATION REPORT (HSE-IIR)

nt Cause analysis

Other

Other

11.3.3 Inadequate examination of parts

Drawings
✘ Witness statements

MNTQ-HSE-FRM-05 Rev. 1.0 Issue Date: 16/04/2017 Page 6/10

 ECONOMIC ZONES COMPANY (MANATEQ)
PROJECTS DEPARTMENT
(HSEMS)

✘
HSE INCIDENT INVESTIGATION REPORT (HSE-I
Name Title Company
Prepared by
Loveson Glariyans Senior HSE Engineer Sacyr UCC JV

Raul Cotilla Lago Project Manager Sacyr UCC JV

Approved by PM *4
HSE Incident Investigation Report sign off by Supervision Consultant (CS)
Contractors Root Cause analysis and corrective actions are reviewed and found satisfactory Yes/ No
Comments:

(CS) HSE
Representative

(CS) PM/SRE*5
Received by
Contractor
Legend:
LTI*1 Lost Time Injury
RAMS*2 Risk Assessment and Method Statement
MSDS/COSHH*3 Material Safety Data Sheet/ Control of Substances Hazardous to Health
PM*4 Project Manager
SRE*5 Senior Resident Engineer

MNTQ-HSE-FRM-05 Rev. 1.0 Issue Date: 16/04/2017 Page 7/10

TIGATION REPORT (HSE-IIR)
Signature and Date

ort sign off by Supervision Consultant (CS)

d and found satisfactory Yes/ No

MNTQ-HSE-FRM-05 Rev. 1.0 Issue Date: 16/04/2017 Page 8/10

 Source of Injury/Illness Personal Factors Job Factors Mechanism of Injury Unsafe Act Unsafe Conditions Nature of the Injury
Housekeeping 1.Physical Capability 7.Training / Knowledge Transfer 7.1 Inadequate knowledge transfer Contact with machinery 1. Following Procedures 1. Protective Systems Abrasions/Bruising
General access/egress 2.Physical Condition 8.Management /Supervision / Employee Leadership 7.1.1 inability to comprehend Struck by moving object 2. Use of Tools or Equipment 2. Tools, Equipment & Vehicles Burns
Emergency preparedness and response 3.Mental State 9.Contractor Selection & Oversight 7.1.2 inadequate instructor qualifications Struck by moving vehicle 3. Use of Protective Methods 3. Work Exposures to Cuts/Laceration/Open wound
PTW/ NOC/ Permits 4.Mental Stress 10.Engineering / Design 7.1.3 inadequate training equipment Struck against 4. Inattention / Lack of Awareness 4. Work Place Environment / Layout Electric shock
Compressed gas cylinders and air, LPG 5.Behavior 11.Work Plan 7.1.4 misunderstood instructions Lifting and handling injuries 1.1 Inadequate guards or protective devices Foreign body in eye
First Aid and health fitness 6.Skill Level 12.Purchasing, Material Handling & Material Control 7.2 Inadequate recall of training material Slip, trip, fall same level 1.1 Violation by individual 1.2 Defective guards or protective devices Heat related illness
Fire precaution and prevention 13.Tools & Equipment 7.2.1 training not reinforced on the job Fall from height 1.2 Violation by group 1.3 Inadequate personal protective equipment Nerve/Spinal cord injury
Safety of the public 1.1 Vision deficiency 14.Work Rules / Policies / Standards / Procedures (PSP) 7.2.2 inadequate refresher training frequency Heat stress 1.3 Violation by supervisor 1.4 Defective personal protective equipment Poisoning/Toxic effect inhalation
Welfare, safety in the heat 1.2 Hearing deficiency 15.Communication 7.3 Inadequate training effort Trapped by something collapsing 1.4 Operation of equipment without authority 1.5 Inadequate warning systems Skin irritation/ disease
Safety in design/Temporary works 1.3 Other sensory deficiency 7.3.1 inadequate training program design Drowned or asphyxiated 1.5 Improper position or posture for the task 1.6 Defective warning systems Amputation
Safety at Street/Road Works, TMP & Logistics 1.4 Reduced respiratory capacity 7.3.2 inadequate training / objectives Exposure to harmful substance 1.6 Overexertion of physical capability 1.7 Inadequate isolation of process or equipment Concussion
Security on Site 1.5 Other permanent physical disabilities 7.3.3 inadequate new employee orientation Exposed to fire 1.7 Work or motion at improper speed 1.8 Inadequate safety devices Hearing loss/deafness
PPE/RPE/PFPE 1.6 Temporary disabilities 7.3.4 inadequate initial training Exposed to explosion 1.8 Improper lifting 1.9 Defective safety devices Foreign body under skin
Control of Substances Hazardous to Health (COSHH) 1.7 Inability to sustain body positions 7.3.5 inadequate means to determine if qualified for job Contact with electricity 1.9 Improper loading 2.1 Defective equipment Infectious disease
Control of dust, fumes, noise and vibration 1.8 Restricted range of body movement 7.4 No training provided Physical assault 1.10 Shortcuts 2.2 Inadequate equipment Psychological (stress)
Food Safety on Site 1.9 Substance sensitivities or allergies 7.4.1 need for training not identified Workplace Vilonece 2.1 Improper use of equipment 2.3 Improperly prepared equipment Strain/Sprain
Manual Handling and Ergonomics 1.10 Inadequate size or strength 7.4.2 training records incorrect or out of date Horseplay 2.2 Improper use of tools 2.4 Defective tools Bite/Sting
Asbestos, lead 1.11Diminished capacity due to medication 7.4.3 new work methods introduced without training Other 2.3 Use of defective equipment (aware) 2.5 Inadequate tools Crush/ Internal injury
Work at height, Ladders, Scaffolding 2.1 Previous injury or Illness 7.4.4 decision made not to train 2.4 Use of defective tools (aware) 2.6 Improperly prepared tools Dislocation
Working over and near to water 2.2 Fatigue 8.1 Conflicting roles / responsibilities 2.5 Improper placement of tools, equipment or materials 2.7 Defective vehicle Fracture
Safety with steelworks 2.2.1 Fatigue due to Workload 8.1.1 unclear reporting relationships Body Parts 2.6 Operation of equipment at improper speed 2.8 Inadequate vehicle for the purpose Hernia
Portable fixing tools 2.2.2 Fatigue due to lack of rest 8.1.2 conflicting reporting relationship Head/Neck 2.7 Servicing of equipment in operation 2.9 Improperly prepared vehicle Musculoskeletal disorder-Chronic
MEWP, Hoists and Hoist towers 2.2.3 Fatigue due to sensory overload 8.1.3 unclear assignment of responsibility Trunk 3.1 Lack of knowledge of hazards present 3.1 Fire or explosion Poisoning/Toxic effect ingestion
Lifting Equipment, gears and operations 2.3 Diminished performance 8.1.4 conflicting assignment of responsibility Upper Extremity 3.2 Personal protective equipment not used 3.2 Noise Respiratory disease
Plant and work equipment (mobile/static) 2.3.1 due to temperature extremes 8.1.5 improper or insufficient delegation of authority Lower Extremity 3.3 Improper use of proper personal protective equipment 3.3 Energized electrical systems Other
Lone working 2.3.2 due to oxygen deficiency 8.2 Inadequate leadership Internal Organs 3.4 Servicing of energized equipment 3.4 Energized systems, other than electrical
Electrical safety on site 2.3.3 due to atmospheric pressure variation 8.2.1 standards of performance missing or not enforced 3.5 Equipment or materials not secured 3.5 Radiation
Excavation works 2.4 Blood sugar insufficiency 8.2.2 inadequate accountability Body Parts 3.6 Disabled guards, warning systems or safety devices 3.6 Temperature extremes
Confined spaces 2.5 Impairment due to drug or alcohol use 8.2.3 inadequate or incorrect performance feedback Head/Neck 3.7 Removal of guards, warning systems or safety devices 3.7 Hazardous chemicals
Safety in demolition 3.1 Poor judgment 8.2.4 inadequate work site walk-through Cervical Spine 3.8Personal protective equipment not available 3.8 Mechanical hazards
Safety in piling, tunnel, shaft, cofferdams 3.2 Memory failure 8.2.5 inadequate safety promotion Face exclusing eye 4.1 Improper decision making or lack of judgment 3.9 Clutter or debris
Formworks/false work 3.3 Poor coordination or reaction time 8.3 Inadequate correction of prior hazard / incident Neck 4.2 Distracted by other concerns 3.10 Storms or acts of nature
Waste management and Environment 3.4 Emotional disturbance 8.4 Inadequate identification of worksite / job hazards Ear 4.3 Inattention to footing and surroundings 3.11 Slippery floors or walkways
Stores 3.5 Fears or phobias 8.5 Inadequate management of change system Forehead 4.4 Horseplay 4.1 Congestion or restricted motion
Vehicle fuels 3.6 Low mechanical aptitude 8.6 Inadequate incident reporting / investigation system Nose 4.5 Acts of violence 4.2 Inadequate or excessive illumination
3.7 Low learning aptitude 8.7 Inadequate or lack of safety meetings Eye 4.6 Failure to warn 4.3 Inadequate ventilation
3.8 Influenced by medication 8.8 Inadequate performance measurement & assessment Mouth 4.7 Use of drugs or alcohol 4.4 Unprotected height
4.1 Preoccupation with problems 9.1 Lack of contractor pre-qualifications Scalp/Skull 4.8 Routine activity without thought 4.5 Inadequate work place layout
4.2 Frustration 9.2 Inadequate contractor prequalification’s Trunk Other 4.5.1 controls less than adequate
4.3 Confusing directions / demands 9.3 Inadequate contractor selection Abdomen 4.5.2 displays less than adequate
4.4 Conflicting directions / demands 9.4 Use of non –approved contractor Pelvis 4.5.3 labels less than adequate
4.5 Meaningless or degrading activities 9.5 Lack of job oversight Back 4.5.4 locations out of reach or sight
4.6 Emotional overload 9.6 Inadequate oversight Spine 4.5.5 conflicting information is presented
4.7 Extreme judgment / decision demands 10.1Inadequate technical design Genitals Other
4.8 Extreme concentration / perception demands 10.1.1 design input obsolete Thorax
4.9 Extreme boredom 10.1.2 design input not correct Upper Extremity
5.1Improper performance is rewarded 10.1.3 design input not available Clavicle (collar bone)
5.1.1 saves time or effort 10.1.4 design output inadequate Forearm
5.1.2 avoids discomfort 10.1.5 design input infeasible Thumb
5.1.3 gains attention 10.1.6 design output unclear Elbow
5.2Improper supervisory example 10.1.7 design output not correct Hand
5.3 Inadequate identification of critical safe behaviors 10.1.8 design output inconsistent Upper arm
5.4 Inadequate reinforcement of critical safe behaviors 10.1.9 no independent design review Fingers
5.4.1 proper performance is criticized 10.2 Inadequate standards, specifications, and / or design criteria Shoulder
5.4.2 inappropriate peer pressure 10.3 Inadequate assessment of potential failure Wrist
5.4.3 inadequate performance feedback 10.4 Inadequate ergonomic design Lower Extremity
5.4.4 inadequate disciplinary process 10.5 Inadequate monitoring of construction Ankle
5.5 Inappropriate aggression 10.6 Inadequate assessment of operational readiness Hip/Groin
5.5 Improper use of production incentives 10.7 Inadequate monitoring of initial operation Thigh
5.7 Supervisor implied haste 10.8 Inadequate evaluation and / or documentation of change Buttocks
5.8 Employee perceived haste 11.1 Inadequate work planning Knee
6.1 Inadequate assessment of required skills 11.2 Inadequate preventive maintenance Toes
6.2 Inadequate practice of skill 11.2.1Inadequate assessment of needs Foot
6.3 Infrequent performance of skill 11.2.2 Inadequate lubrication /servicing Lower leg
6.4 Lack of coaching on skill 11.2.3 Inadequate adjustment /assembly Internal Organs
6.5 Insufficient review of instruction to establish skill 11.2.4 Inadequate cleaning /resurfacing Arteries
Other 11.3 Inadequate repair Intestines
11.3.1 Inadequate communication of needed repair Lungs
11.3.2Inadequat scheduling of work Brain
11.3.3 Inadequate examination of parts Kidney
11.3.4 Inadequate parts substitution Spleen
11.4 Excessive wear and tear Heart
11.4.1 inadequate planning for use Liver
11.4.2 Inadequate extension of service life Stomach
11.4.3 improper loading
11.4.4 use by untrained people
11.4.5 use for wrong purpose
11.5 Inadequate reference materials or publications
11.6 Inadequate audit / inspection / monitoring
11.6.1 no documentation
11.6.2 no correction responsibility assigned
11.6.3 no accountability or corrective action
11.7 Inadequate job placement
11.7.1 appropriate personnel not identified
11.7.2 appropriate personnel not available
11.7.3 appropriate personnel not provided
12.1 Incorrect item received
12.1.1 inadequate specifications to vendor
12.1.2 inadequate specifications on requisition
12.1.3 inadequate control on changes to orders
12.1.4 unauthorized substitution
12.1.5 inadequate product acceptance requirements
12.1.6 no acceptance verification performed
12.2 Inadequate research on materials / equipment
12.3 Inadequate mode or route of shipment
12.4 Improper handling of materials
12.5 Improper storage of materials or spare parts
12.6 Inadequate material packaging
12.7 Material shelf life exceeded
12.8 Improper identification of hazardous materials
12.9 Improper salvage and / or waste disposal
12.10 Inadequate use of safety and health data
13.1 Inadequate assessment of needs and risks
13.2 Inadequate human factors / ergonomics considerations
13.3 Inadequate standards or specifications
13.4 Inadequate availability
13.5 Inadequate adjustment / repair / maintenance
13,6 Inadequate salvage and reclamation
13.7 Inadequate removal / replacement of unsuitable items
13.8 No equipment record history
13.9 Inadequate equipment record history
14.1 Lack of PSP for the task
14.1.1 lack of defined responsibility for PSP
14.1.2 lack of job safety analysis
14.1.3 inadequate job safety analysis
14.2 Inadequate development of PSP
14.2.1 inadequate coordination with process / equipment design
14.2.2 inadequate employee involvement in the development
14.2.3 inadequate definition of corrective actions
14.2.4 inadequate format for easy use
14.3 Inadequate implementation of PSP, due to deficiencies
14.3.1 contradictory requirements
14.3.2 confusing format
14.3.3 more than one action per step
14.3.4 no check- off spaces provided
14.3.5 inaccurate sequence of steps
14.3.6 confusing instructions
14.3.7 technical error / missing steps
14.3.8 excessive references
14.3.9 potential situations not covered
14.4 Inadequate enforcement of PSP
14.4.1 inadequate monitoring of work
14.4.2 inadequate supervisory knowledge
14.4.3 inadequate reinforcement
14.4.4 non-compliance not corrected
14.5 Inadequate communication of PSP
14.5.1 incomplete distribution to work groups
14.5.2 inadequate translation to appropriate languages
14.5.3 incomplete integration with training
14.5.4 out of date revisions still in use
15.1 Inadequate horizontal communication between peers
15.2 Inadequate vertical communication between supervisor and person
15.3 Inadequate communication between different Organizations
15.4 Inadequate communication between work groups
15.5 Inadequate communication between shifts
15.6 inadequate communication method
15.7 No communication method available
15.8 Incorrect instructions
15.9 Inadequate communication due to job turnover
15.10 Inadequate communication of safety and health data, regulations or guidelines
15.11 Standard terminology not used
15.12 Verification / repeat back techniques not used
15.13 Messages too long
15.14 Speech interference

15.15 Other