REPORT of INJURY

INCIDENT SEVERITY: 2 P E A
2 HQ / SUBSIDIARY:

IMPACTED ELEMENT:
Bonati contractor company
FUNCTION AND DEPT. INJURED PERSON
NAME SURNAME A) JOB WAREHOUSE WORKER ELECTRICAL MAINT. MECHANICAL MAINT. INSTRUMENTATION MAINT. LABORATORY PERSONNEL
OFFICE PERSON MARINE CREW

1
JOB CENTER

COMPANY

EVENT LOCATION EVENT N

Bonati new camp construction

in case of INJURY in ITINERE YES TIME NO

REGISTRATION AGE HIRED in YEAR JOB SENIORITY

2013-INC-004

WIRE- LINE PERSON.- W/O MANAGEMENT SUPERVISOR TECHNICIAN VISITOR DRIVER OTHER (Specify)

INCIDENT DATE

22 /04/2013

15:30 AM

ABANDONMENT DATE WORK SHIFT 1 2 ACTIVITY COVERED by WORK PERMIT / RISK ASSESSMENTYES
3 D

NO Excavator machine hit and broke down the EVENT DESCRIPTION underground water supply line to the JTS, Agip camps Today 22nd of April at approximately 4 pm the Bonati group start performing the excavation activities to install the fence posts all around their a new camp location accidently while using of the caused a huge water leak. excavator machine the operator hit and broke down the underground water supply line to the JTS, Agip camps caused a huge water leakage on all area around leakage on all area around

PRODUCTION PERSON.

B) EVENT LOCATION GAS / OIL PLANT DRILLING SITE CONSTRUCTION SITE PRODUCTION PTF. DRILLING PTF. PTF. IN CONSTRUCTION
MAIN OFFICE

ROAD WELL SUPPLY BASE OTHER (Specify)

near to MAN camp

G) TREATMENT SITE COMPANY SURGERY EXTERN. MEDICAL SURG. HOSPITAL

C) EVENT SITE WELL HEAD AREA PROCESS PLANT TANK AREA RIG FLOOR YARD WORKSHOP INSTRUMENTAL/CHEM. LAB. ELET: CAB/CONTROL ROOM WAREHOUSE KITCHEN/QUARTERS OFFICE OWN VEHICLE COMPANY VEHICLE PIER THIRD PARTY VEHICLE OTHER (Specify)

D) ACCIDENT TYPE E) CONTINGENT EVENT COLLISION WITH FALL of OBJECTS ELECTRICAL EQUIPMENT HIT BY OBJ. IMPROPERLY PLACED WELDING/CUTTING CRUSHED BY HAND TOOLS ADVERSE WEATHER RUN OVER BY ... MATERIALS HANDLING WHEELS, DRILLS, LATHES CUT INSTRUMENT MAINTEN. VEHICLES/EQUIPMENT EXCESSIVE PHISICAL STRAIN DESCEND from VEHICLES WORKING SURFACE/FLOOR FLAT FALL OPERATIONS in ELEVAT. ROAD ACCIDENT FALL FROM HEIGHT STAIRS & SCAFFOLDING ROAD CONDITIONS SLIPPED / TRIPPED TRANSFERRING FLUIDS OTHER (Specify) INHAL, INGEST, ABSORB. TRANSFERRING PEOPLE CONTACT DANGEROUS SUBST. CONTACT H/L TEMP. F) INCIDENT TYPE ELECTROCUTION FIRE PLANE CRASH ON BOARD / DRIVING... EXPLOSION NAVAL ACCIDENT OTHER (Specify) TOXIC SUBSTANCES RELEASE TRIPS/SLIPS AND FALLS STRUCTURES COLLAPSE OTHER (Specify) SPILL/DISCHARGED OTHER (Specify)

underground pipe hited while excavatoin activity

RESPIRATORY SYSTEM CARDIO VASC. SYSTEM DIGESTIVE SYSTEM MULTIPLE HEAD/LIMBS MULTIPLE HEAD/CHEST MULTIPLE CHEST/LIMBS MULTIPLE UPP/LOW LIMBS OTHER (Specify) I) INJURIES TYPE WOUNDS ABRASIONS BRIUSES and CRUSHING DISLOCATION, SPRAIN, STRAIN BACKLASH FRACTURE / INFRACTION CONCUSSION/ INTERNAL TRAUMA STRAIN INJURY MULTIPLE INJURIES FATAL ACCIDENT CASE INJURIES from FOREIGN BODIES/SUBST. INJURIES from HEAT/COLD INTOXICATION AMPUTATION ELECTROCUTION IONIZING RADIATION SUFFOCATION / DROWNING MEDICAL TREATMENT CASE OTHER (Specify)

H) INJURIES LOCATION HEAD HAND/WRIST/FINGER FACE BACK/SPINAL COL. EYE ARM/SHOULDER EAR FOOT/ANKLE NOSE CHEST REGION MOUTH LUMBAR-SACRAL REGION NECK ABDOMINAL REGION LEG GROIN

REMARKS

The excavation activities have been postponed due to:1-No work permit has been applied for these activities 2- Lack of supervision 3- No safety representative in the location for Bonati contractor

WITNESSES

WORKING TEAM OCCASIONAL

Naji Elmari

/ /
HSEQ

Signature Signature

/ / SUPERVISOR

INJURED PERSON Signature (if possible)

REPORT COMPILER

DIAGNOSIS

FIRST PROGNOSIS

DEPARTMENT MANAGER HSE REPRESENTATIVE SUBSIDIARY GEN. MANAGER REPORT COMPILATION DATE
Naji Elmari
Massimo Vergani 23/04/2013

Signature Signature Signature

MOG-HSEQ-F-085 Rev A4 Accident/Incident