ACCIDENT INCIDENT NOTIFICATION REPORT

ACCIDENT INCIDENT PROCEDURE

Non-Injury Accident Report/ (Property Damage) Ref. No. TCF1/AZ/PD02

NOTE: This form is also used for reporting near-misses Are you reporting a NEAR-MISS? YES / NO If YES,
give details in the ‘What Happened’ box

DETAILS OF PERSON MAKING THE NON-INJURY ACCIDENT REPORT

Name Muhammad Tariq

Name of Employer (if a Contractor) AZMEEL

Job Title HSE Manager Works Number

WHAT HAPPENED? (TO BE COMPLETED BY THE PERSON REPORTING THE INCIDENT)

Date 28/3/2021 Time Around 18:30 Hrs. Location TCF1

Around 7 o clock received message from PM TCF1 Eng. Mr. faatyer that to find out what happened In Tammimi
kitchen.

So HSE Manager along with Mr. Hafiz HSE Officer & Mr.Adil Mustafa HSE Supervisor departed for TCF1 camp
immediately. 20:00 Hrs we reached at TCF1.Started analysing the situation fire was already suppressed before
our arrival. we started investigation and inspected the affected area of the kitchen.

Tamimi manager Mr. Rafeeeq.

One Tamimi worker hit the potato pillar machine accidently with his knee and suddenly gas line is raptured and
fire explosion occurred.

First Aid Case.

Unfortunately, one Tamimi workers leg partially burnt due to fire explosion. He was given first aid after that
shifted to medical facility for further treatment.

What Action was Taken Immediate after incident?

Shut off the power supply and extinguished the fire all the equipment’s inside kitchen are isolated to prevent
the further damage secured the area all personals are evacuated safely.

What action was required after Incident to avoid reoccurrence? (Action, Recommendations)

1.Conduct daily inspection of all equipment’s and power sources.

2.Have to apply the guidelines of MMI (Man Machine interface)
3 All the Appliances should be secured and isolated.
4 Kitchen staff must be trained
5 Before start the work after the incident, all worker should be get the refresh training

Name of reporter Muhammad Tariq Signature Date 27/03/2021

 ACCIDENT INCIDENT NOTIFICATION REPORT

Name of HSE Signature Date 27/03/2021

Representative

HSE Manager Muhammad Tariq Signature Date 27/03/2021

Iqama of involved person.

Picture of damaged security barrier.