OPGC II, Incident Preliminary Report

1. Incident information Details:

Sl Sl
Item Information Item Information
No No
1 Place of Incident 8 IP’s Name
IP Date of
2 Exact location 9
Birth
3 Date & Time 10 Injury Details
Body Part
4 Main EPC 11
Injured
IP’s Gate Pass
5 Sub-Contractor if any 12
No.
6 Job Sup. Name 13 Name of
7 Date of Joining Duty 14 Witness

2. Classification of Incident:
NM MTC Fire Road Dangerous
FAC RWC LTI FAT Other
Non SIP SIP Incident Incident occurrence

3. Activity Type:
Height Work Hot work Machine Guarding
Excavation Confined Space Vehicle Movement
Scaffolding Electrical Construction Equipment
Hoist & Rigging Portable & Power Hand Tools Housekeeping
Material Handling Environmental Spill Painting
Insulation Hydro test Commissioning
Rotatory Part Commisioning Hot work Flash Over
Chemical Handling Operation plant maintanance

Incident Description:

Immediate Action Taken:


Immediate causes:

Action Taken to Correct:


Note: This preliminary incident report to be filled and forwarded to OPGC II HSE department within 12 hrs.