Document

240-94026713 Rev 4
Identifier
Business Management System
Effective Date 04/03/2020
Initial Notification of Occurrence
(INO) Review Date 04/03/2025

Page 1 of 4

NOTE: Only one accident/incident to be reported per initial notification.

NOTE: This document must be saved and reported on the e-mail as Initial Notification. On the file name the Date of Incident, the Injury Classification – Initial and Surname of Injured and the
Site/Department name where the incident happened. Example: 30102013 First Aid – J Bloggs Camden Projects
This report must be verified for correctness/accuracy by the BU/Divisional SHEQ Managers before being submitted to SHEQ Centre of Excellence for capturing on SAP.
(REPORT TO BE SUBMITTED BEFORE THE END OF SHIFT OR DAY) AREA/FARM/TOWN DETAIL:
PRODUCT GROUP/ BUSINESS UNIT BMS SITE Matla Power Station DEPARTMENT OPS
UNIT/SECTION/PROJECT OPS DATE OF INCIDENT 17/07/2021 TIME OF INCIDENT 04h40am

YES NO YES NO
PLACE OF INCIDENT Matla Ash dust plant Unit 1 WORK RELATED x REPEAT x

INCIDENT CONSEQUENCE – MARK THE APPROPRIATE BOX WITH AN X

No Yes
PROPERTY ENVIRONMENT OHS SECTION ELEC
INJURY x CRIME NEAR MISS
DAMAGE CONTRAVENTION 24 CONTACT

NOTE: To classify an Environmental incident please complete page 3 before indicating either Environmental Legal Contravention or Environmental Event below.
INJURY CLASSIFICATION – MARK THE APPROPRIATE BOX WITH AN X

MEDICAL(NO SHIFT LOST TIME INCIDENT OCCUPATIONAL OCCUPATIONAL

FIRST AID FATALITY
LOSS) (SHIFT LOSS) DISEASE (INTERNAL) DISEASE (EXTERNAL)

INCIDENT PRIORITY RATING – MARK THE APPROPRIATE BOX WITH AN X

LOW MINOR MODERATE MAJOR CRITICAL
ACTUAL OUTCOME x

POTENTIAL OUTCOME x

Frequent Likely Possible Unlikely Rare

LIKELIHOOD x

NOTE: The priority level is calculated on SAP which will inform actions required to manage and investigate the incident.
TYPE OF CONTACT/INCIDENT CAUSED BY – MARK THE APPROPRIATE BOX WITH AN X
MOTOR OD EXPOSURE
FALL/
VEHICLE x THEFT HI-JACKING INSECT BITE ERGONOMICS ASSAULT
TRIP/SLIP
ACCIDENT

CAUGHT IN
BETWEEN OIL/PETROL/
STRUCK ASH CONTACT OPERATING
DIESEL COAL SPILL CUT BY
BY/AGAINST SPILL WITH FUMES ERROR
SPILL

OTHER (describe)

TASK INFORMATION CLARIFICATION – MARK THE APPROPRIATE BOX WITH AN (Y=yes or N =no)
HIRA IN PLACE x EQUIPMENT IN GOOD CONDITION PROCEDURE IN PLACE TRAINING TAKEN PLACE x

INJURED DETAILS – MARK THE APPROPRIATE BOX WITH AN X AND ADD COMPANY NAME

FULL NAME (No initials) *EMP/LB/CNTR/PCTR/MoP COMPANY NAME UNIQUE NO./ID NO. AGE SERVICE PERIOD

Lucas Ngwenya EMP ERI 4573920 58 7 Years

EMP=EMPLOYEE, LB = LABOUR BROKER, CNTR=CONTRACTOR, PCNTR=PRINCIPAL CONTRACTOR, MoP =MEMBER OF THE PUBLIC
FULL NAME(S) OF WITNESS(S)
FULL NAME *EMP/LB/CNTR/PCTR COMPANY NAME UNIQUE NO. /ID NO. TEL NUMBER

Christopher Putter EMP ERI 0824470474

MOTOR VEHICLE ACCIDENT

FULL NAME(S) OF DRIVER(S) VEHICLE REGISTRATION COMPANY/THIRD PARTY

DETAILED DESCRIPTION OF THE INCIDENT

Controlled Disclosure
When downloaded from the document management system, this document is uncontrolled and the responsibility rests with the user to ensure it is in line with the
authorised version on the system.
No part of this document may be reproduced without the expressed consent of the copyright holder, Eskom Rotek Industries SOC Ltd

Hard copy printed on: 21/02/2017

 Document
240-94026713 Rev 4
Identifier
Business Management System
Effective Date 04/03/2020
Initial Notification of Occurrence
(INO) Review Date 04/03/2025

Page 2 of 4

On the 17 July 2021 at approximately 22h00, the night shift reported to work and continued with their daily tasks. In the early hours of Saturday the injured employee was tasked to go and fill up
the instrument air compressor at Unit 1Ash Plant, during the process of preparation the injured fell into an open drain injuring his right hand ankle. The task was stopped immediately and incident
was reported to ERT Team and to Management. Apparently the decision was taken for the removal of the instrument air compressor from the Slurry plant to Unit 1 Dust Plant. On the 16 July
2021.the employee was attended by ERT Team on site and transported to Witbank Cosmos hospital. The X-ray was done and revealed no fracture only a soft tissue injury. The injured was not
referred to another medical practitioner, The injured was discharged the same day and advised to make a follow up on Monday to see doctor Spoestra. SHEQ arranged with scaffolding company
to install the solid barricading in the area, the barricading was installed immediately.

REPORTED BY Christopher Putter DATE 17/07/2021 TELEPHONE NUMBER 0824470474

CONTACT PERSON AND DETAILS SHOULD MORE INFORMATION BE REQUIRED
NAME Obed Skosana DESIGNATION SHE Officer TELEPHONE NUMBER 0829054132

PRELIMINARY FINDINGS:
 The incident reporting process was followed
 The supervisor on shift did not approve the employee risk assessment
 The task for filling up the diesel was not included on a risk assessment
 The employee was injured on his R/H ankle
 The trench was open without a cover
 The team was busy filling up a diesel into the instrument air compressor
 The instrument air compressor was removed from the Slurry Plant on the 16 July 2021 due to excessive dust

IMMEDIATE CORRECTIVE ACTION TO PREVENT REOCCURENCE OF SIMILAR INCIDENT:

 The activity was stopped immediately and reported the incident to management
 Work stoppage was conducted
 The injured was transported to Witbank Cosmos hospital
 The area was solid barricaded

NAME AND CONTACT DETAILS OF AREA SUPERVISOR OR MANAGER

FULL NAME UNIQUE NUMBER/IDENTIFICATION NUMBER TELEPHONE NUMBER

Simphiwe Ngubeni 4558365 0827699227

Steps involved in Incident Prioritisation

Step 1: Determine the actual and potential outcome, consequence and severity of the incident by using the consequence table. For injuries actual and potential outcome must be the same.
For near miss the actual and potential outcome may be different.
Step 2: Determine the likelihood of a recurrence of this incident by using the Likelihood table. Repeat incidents must increase the priority profile of the incident.
Step 3: Quantify the level of risk associated with the incident by allocating or assigning a priority rating to the incident. Using the information obtained in Steps 1 and 2 of this process and
determines the priority rating.
Step 4: Determine the appropriate action to be taken, e.g. priorities, appropriate management of the incident, level of response, classification and reporting, etc. as described in table on
Action required.
Step 5: If the severity of the incident changes i.e.: lost time injury to a fatality or environmental legal contravention to OHD, the priority rating of the incident must be reviewed and amended
where necessary, including updating relevant information in SAP EH&S.
Consequence Table
Consequences Low/Minimum Minor Moderate Major Serious/Critical
Fatalities/injuries to Eskom First-aid or medical Lost time injury where OHS Act section 24 (a) A single fatality, a serious Multiple fatalities
and/or contractor employees treatment case fewer than 14 days were (excluding fatalities) incident (see definition of
lost. Serious incident)
Occupational Resulted in Resulted in Resulted in Resulted in Resulted in
Hygiene irritation or single reversible multiple reversible single multiple
Incidents nuisance occupational occupational permanent permanent
illness illness disability/ disability/
irreversible irreversible
occupational occupational
Illness. Illnesses.
Note: All NIHL Note: All
cases where NIHL cases
the PLH shift where the
of between PLH shift of
6.4% and 10% 10% and
will be greater will be
regarded as regarded as
incidents and incidents and
need to be need to be
investigated in investigated
terms of SANS in terms of
10083. SANS 10083.
Fatalities/injuries First-aid or Incidents that Incidents that A single Multiple
to members of medical resulted in resulted in Fatality. Fatalities.
the public Treatment case. hospitalisation hospitalisation
(Not ICU). (ICU).
Occupational Potential to result Potential to Potential to result Potential to Potential to
Hygiene near miss in irritation or result in single in multiple result in single result in
incidents Nuisance. reversible reversible permanent multiple
(within the same occupational occupational disability/ permanent
OU/BU) Illness. Illnesses. irreversible disability/
occupational irreversible
Illness. See occupational
Note 4 below. Illnesses.
See note 4
Below.

Controlled Disclosure
When downloaded from the document management system, this document is uncontrolled and the responsibility rests with the user to ensure it is in line with the
authorised version on the system.
No part of this document may be reproduced without the expressed consent of the copyright holder, Eskom Rotek Industries SOC Ltd

Hard copy printed on: 21/02/2017

 Document
240-94026713 Rev 4
Identifier
Business Management System
Effective Date 04/03/2020
Initial Notification of Occurrence
(INO) Review Date 04/03/2025

Page 3 of 4

Eskom and/or Could have Could have Could have Could have Could have
contractor resulted, or resulted, or resulted, or resulted, or resulted, or
employee near miss previously did previously did previously did previously did previously did
incidents result, in a first aid result, in a lost time result, in a lost time result, in a result, in
(within the same or medical injury injury where single fatality multiple
OU/ BU) Treatment case. where fewer 14 days or more or a serious Fatalities.
than 14 days were lost. Incident.
were lost.
Environmental incidents Little or no Minor ecological Aspect could Aspect could Aspect has a
ecological effect Effect. result in a result in a recognised
and no Ecological moderate major global
measurable damage can be uncontained or uncontained or environmental
impact on human remedied within sustained sustained impact.
Health. Six months. environmental environmental Widespread
Minor hazard to release, impacting release, or permanent
humans in the the local impacting the local
immediate Environment only. regional ecological
Vicinity. Ecological environment damage.
damage can be only. Remediation
remedied in less Ecological would take
than one year. damage can longer than
Health hazard to be remedied one year.
humans in the within 1 year. Could result
immediate vicinity, Health hazard in a major
but not resulting in to humans in public health
critical or fatal the immediate hazard.
Injury/illness. vicinity Magnitude is
resulting in unknown.
critical or fatal Incident gives
injury/illness. rise to a legal
Incident gives contravention.
rise to a legal
contravention.

Likelihood Table
Probability Categories Likelihood or recurrence of event Description
Frequent, Almost certain 1 or more times per month Is expected to occur again either immediately or within a short period of time (i.e. within the next few
weeks)
Likely Occurs once per month Will probably occur in most circumstances (several times a year)
Possible Occurs once per year or every 2 Years Possibly will recur – might occur at some time (may happen every 1 to 2 years)
Unlikely Occurs more than once every 10 Years Possibly will recur – could occur at some time in the next 2 to 5 years
Rare Occurs once every 10 years or once in a Unlikely to occur – may occur only in exceptional circumstances (may happen every 10 to 100 years)
lifetime
Priority Matrix
Consequence/Severity
Low/Minimum Minor Moderate Major Serious/Critical
Frequent, almost certain Moderate Moderate High Extreme Extreme
Likely Low Moderate High Extreme Extreme
Likelihood Possible Low Moderate Moderate Extreme Extreme
Unlikely Low Low Moderate Extreme Extreme
Rare Low Low Moderate Extreme Extreme
Environmental
Guide Incident detail

The applicable Act with specific reference to the section of the

Reference Legislation act contravened should be included here. This data is
available from Division Legal Registers.

Full details of the event must be given i.e.: Chemical Spill,

Nature of Event including whether the event is considered an “Emergency
Incident” in terms of NEMA or NWA.
Details of Communication with List details of interaction with authorities. This should include
Regulatory Authority dates and media used, and copies of any correspondence.

Results of Evaluation to
As per flow diagram set out in EPC 32-249 Annexure H.
Determine If a “Repeat Event”
ELC Criteria for Classification of Legal and OHD Contravention's
Element N/A Yes No
1. Did the event result in either: sterilising the soil, or, destroying rare, endangered or protected fauna or flora?
2. Did the event result in making any water resource unfit for its original purpose such as: domestic, agricultural, industrial use or
reduce the water quality to such a state that human intervention is required to restore it to its original quality?
3. Were reasonable measures taken to prevent pollution or degradation from occurring?
4. Were measures taken to prevent pollution or degradation from continuing?
5. Were measures taken to prevent pollution or degradation from recurring?
6. Was the incident reported to the authorities?
7. Were measures taken to contain and minimise the effects of the event on the environment and to the Health, Safety and
Property of persons?
8. Was event report submitted within fourteen (14) days to the authorities providing the information required i.e. NEMA section
30(5) (a-e)?
9. Contravention of any other environmental legislation? (List if applicable)
10. CLASSIFIED AS ENVIRONMENTAL LEGAL CONTRAVENTION (if “Yes” for 1, 2 or 9 or “No” for any from 3 - 8) (Any Shaded Area Marked)
11. CLASSIFIED AS ENVIRONMENTAL EVENT (if “No” for 1, 2 or 9 or “Yes” for any from 3 - 8)
NOTE: If Classified as an Environmental Legal Contravention, Check Against Following Criteria.
Controlled Disclosure
When downloaded from the document management system, this document is uncontrolled and the responsibility rests with the user to ensure it is in line with the
authorised version on the system.
No part of this document may be reproduced without the expressed consent of the copyright holder, Eskom Rotek Industries SOC Ltd

Hard copy printed on: 21/02/2017

 Document
240-94026713 Rev 4
Identifier
Business Management System
Effective Date 04/03/2020
Initial Notification of Occurrence
(INO) Review Date 04/03/2025

Page 4 of 4

Criteria Yes No
1. 0
2. Contravention reported within the Division.
3. Contravention reported to appropriate Government Department.
4. Registered on OHD by ELC member in consultation with MD.
5. Contravention was addressed timeously.
6. Repeat legal contravention
OHD EVENT (Any shaded area marked)
Compiled By

Name O Skosana Date 17/07/2021

Controlled Disclosure
When downloaded from the document management system, this document is uncontrolled and the responsibility rests with the user to ensure it is in line with the
authorised version on the system.
No part of this document may be reproduced without the expressed consent of the copyright holder, Eskom Rotek Industries SOC Ltd

Hard copy printed on: 21/02/2017