HEALTH SAFETY & ENVIRONMENT

INCIDENT/ACCIDENT NOTIFICATION REPORT

PERSON NAME Amjad Ali EXACT LOCATION Opposite 6 Male Washroom
(SRH)
COMPANY/DEPT. DATE OF INCIDENT 31/03/2024
CATEGORY TIME OF INCIDENT 18:30 PM
NATIONALITY TIME/DATE REPORTED 18:40 PM-31/03/2024
AGE/GENDER WEATHER CONDITIONS NORMAL
INCIDENT CATEGORY: ✘ Precautionary
First Aid Medical Treatment Case Restricted Work Case
Lost Time Injury Fatal Near Miss Environment ✘ Property Damage
Fire
Other (specify) – The lock of the door was broken to save the man.
INCIDENT TYPE: Explosion Security Transport Crane Operations Fire Electrical
Assault Lifting Falling Liquid Release Flying Objects Natural Disaster Tripping
Gas Release Structure Collapse Crushing Slipping
Others (Specify): Stuck behind door

INJURY LOCATION: ✘ None Head Leg Forehead Foot Eye Back Body
Face Lips Neck Chest Finger Arm Hand Nose
Other (specify):
INJURY TYPE: ✘ None Cut Bruise Burn Break Sprain Strain Twist Inhalation
Pain Dislocation Chemical Abrasion Laceration Swelling
Other (specify):

BRIEF DESCRIPTION OF INCIDENT: Describe What Happened (5w1H).

Information from -At around 16:30 hrs HSE received call from CC team. He informed, someone stuck behind the door
in male washroom.
Incident brief - HSE rushes there and found one of the guests named Amjad Ali who was working in Hall 6 for Al Nuami
Electronic Sale having Emirates ID no-784-1995-8726922-8 was locked inside cubicle of male washroom of opposite 6 as
the door lock was malfunctioned and was not opening. He was perfectly safe after being taken out.

IMMEDIATE ACTIONS TAKEN: Describe What action taken to minimize the risk and impact of incident.
 Called Engineering team immediately to break the lock.

IMMEDIATE CAUSE OF INCIDENT: Describe What was the immediate cause of incident.

 Non-reported incident

ROOT CAUSE OF INCIDENT: Describe What was the root cause of incident.
Investigation not complete

RECOMMENDATION: Describe Actions That Will Be Taken to Prevent Recurrence.

Investigation not complete

DWTC Incident ACCIDENT NOTIFICATION Form | HSE/February 2023/Revision 02

 HEALTH SAFETY & ENVIRONMENT
INCIDENT/ACCIDENT NOTIFICATION REPORT
DETAILS OF PERSON MAKING THIS REPORT:
Name: Saquib javed
Date: 01/04/2024
Signature: Saquib Javed
PICTORIAL EVIDENCE:

DWTC Incident ACCIDENT NOTIFICATION Form | HSE/February 2023/Revision 02