SADIOLA INTERNAL

INCIDENT NOTIFICATION TEMPLATE

This is NOT an investigation report, but an initial Notification report within a specific timeframe as required in terms of the
SEMOS SA Incident immediate response and notification procedure. The information reflected is based on a preliminary
assessment of the incident and is not a formal investigation
Country Mali Operation Sadiola
Area/ Location Administration parking area Discipline/Depart Driving/Administration
Date of Incident 27 December 2023 Time of incident 08H45
Incident Category Health and Environment Community/ Compliance/ Production or Financial Security
Safety Reputation Regulatory loss or Business
interruption
Type of Incident (e.g
Fall of ground) Vehicle incident

Actual Impact
Low Minor Moderate Major High
Classification
Potential Impact
Classification
Low Minor Moderate Major High
(Taking into account
the controls in place)
On the 27th of December 2023 @ 08 45, while parking the toy 92, the right-side mirror
had a hit on the pole which resulted in breaking the mirror.

Brief Description of
the incident

Impact on the mirror

Document: 4_SAD_OHS Sadiola Internal Incident Notification Template English F045.

Prepared By O. DIARRA Approved By E. GOITA
Issue Date: 12 June -13 Print Date: 28-Dec-23 Review Date:
Version No: 01 Page No: Page 1 of 2
THIS DOCUMENT IS UNCONTROLLED IN HARD COPY
 • The HOD met with the involved driver for an account of.
• The GM met with the involved driver for an account of.
Immediate actions
• Reverse parking drill scheduled for the driver in order to reinforce his skill.
• The Safety Department was informed.
• Be vigilant when reversing.
Learning • Always use the rear-view mirror when reversing.
• Drive slowly in reverse.
Signed (Responsible
Manager) Administration HOD original copy
Date 27 December 2023
signed off

Document: 4_SAD_OHS Sadiola Internal Incident Notification Template English F045.

Prepared By O. DIARRA Approved By E. GOITA
Issue Date: 12 June -13 Print Date: 28-Dec-23 Review Date:
Version No: 01 Page No: Page 2 of 2
THIS DOCUMENT IS UNCONTROLLED IN HARD COPY