Akakus Oil Operations

PRELIMINARY INCIDENT NOTIFICATION FORM

Document No: FORM – HS - 08 Rev 3

Send by E-mail within 2hrs of Incident to Safety and Environmental Advisor – Tripoli
(Where necessary supplement information with a phone call - Ext 7034)
Key Point: Destroy this form on receipt of completed Final Incident Report Form. Only the
final accurate report should remain on file.

Location: Incident Number:

Incident Date: Incident Time: 10:10 Am
Reported Issued By:
Specific Location Description: NC-186 Sector-C.
North GPS Coordinate:
Location of incident:
East GPS Coordinate:
Distance from a fixed point near-by: Nearby Sector-C GS
Brief account of incident (Report as fact only what you are clear is fact. Specify the status of
anything else which you report, e.g., a belief or an estimate.

Some material has been stolen from Ferrostaal Company at the construction location.

Immediate actions taken:

Incident Events: If multiple events can be attributed to this incident highlight all relevant categories
(x) (x)
Fatality Vehicle
Lost Time Incident (x) Lifting
Medical Treatment Case Electrical
Near Miss Fire
Oli leak
Equipment Damage
Injury Details :
Name Company Injury Type Brief Description
1.Nil
2.Nill

AOO person in charge of response/

investigation
Position: Construction Supervisor.
Office telephone: EX: 3017
Mobile telephone: 0911536242.