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1、相关文件：YNH001-AZB-460-PRO-006事故事件管理程序Accident / Incident Report事故报告PART 1 INITIAL NOTIFICATION 第一部分：初始报告1. General information 基本信息Date of incident 日期Time 时间Location地点Specific area/site具体区域Serial 编号YNH001-AAA-YNH-SAP-0002. Person involved 当事人Trade 职位：Employer 公司：3. Short description of event 事故的简要描述Wh
2、at happened? 发生了什么？What was the injury / damage? 有什么伤害/损失？4. Immediate action taken as a result of the accident / incident 立即采取的措施5. Provisional Category 暂定的范畴Personal Injury 个人伤害Fatality死亡Over 3 day lost Time损时超3天Over 1 day lost time损时超1天RestrictedWork工作受限Medical Treatment医疗处理First Aid急救Non-Injurio
3、us 无伤害Occupational Ill-health 职业病Damage破坏Hydrocarbon Release碳氢化合物泄漏Environmental环境Near Miss未遂Illness疾病Reportable disease需报告的疾病6. Type of Accident / Incident 事故类型Work Related工作相关Off-duty 下班Travel 旅行Potential Matrix Factor 潜在因素矩阵See section 17 见第17节7. Medical / Compassionate Evacuation 医疗/陪同撤离To (Loca
4、tion) 去的地点:ETA 估计到达时间:Patient escorted有人陪同Yes/No是/否Patient to be met有人照看Yes / No是/否Project / Duty HR Rep. informed已通知项目/当班HR代表Yes / No是/否8. Initial Notification by 初始报告人Senior Site Rep. 现场高级代表Print Name:姓名（印刷体）：Sign:手写签名： Date:日期：9. SHE DEPT. USE ONLY SHE部门填写Senior management to be advised报高级管理层Yes
5、/ No是/否Date advised建议时间PM confirmed项目经理确认AMEC plc to be advised报阿美科公司Yes / No是/否Date advised建议时间Category confirmed种类确认Reportable to SHE向SHE报告Yes / No是/否Date advised建议时间Investigation level调查等级SHE Team Leader SHE小组领导Print Name:姓名（印刷体）：Sign:手写签名： Date:日期：Initial Notification (this Page) to be submitted
6、 to HSSE Dept. within 24 hours of the accident/ incident. 本表格第一部分的初始报告应在事故、事件发生后24小时内提交给HSSE部门.PART 2 INVESTIGATION & REPORT 第二部分 调查及报告10. Injured person 当事人Forename(s) 名Surname 姓Date of Birth出生日期Gender性别Male / Female男/女Address 地址11. Witnesses 证明人Name 姓名Address 地址Employer 公司12. Investigation Team 调查
7、团队Name 姓名Title 职位 Employer 公司Leader 组长Member 组员Member 组员Member 组员Member 组员13. Full description of Accident / Incident (Use additional sheet if required) 事故的具体描述14. Details of physical injury (where applicable) 具体伤害 （符合项）（中文详见下一页）Injury Location (tick one box only) Nature of Injury (tick one box only
8、)HeadFingerCrushWhiplashFace / NeckLeg / HipFractureForeign BodyEyeAnkleDislocationAsphyxiation/GassingChestFootPunctureIngestionAbdomenRespiratory SystemCut/Laceration/AbrasionBurn/ScaldBackDigestive SystemStrain/SprainElectric ShockArm / ShoulderGeneralBruising/SwellingIll Health WristMultipleShoc
9、k/ConcussionMultipleHandNot knownLoss of ConsciousnessOtherInternal Damage to OrgansNot known15. Accident / Incident Category / Type (Tick one CATEGORY and one Type relevant to that Category.)FALLS / SLIPSPLANT / EQUIPMENTWORK ENVIRONMENTCOLLAPSE/ OVERTURNSame levelNon-powered hand toolsStepping on/
10、striking againstExcavationLess than 2 metresPortable power toolsFalling/flying objectFalseworkMore than 2 metresFixed power toolsExposure to substance/StructureDown stairs/stepsPowered plantAsphyxia/drowningPlantNon-powered plantStruck by moving vehicleStacked materialMANUAL HANDLINGElectricityEquip
11、mentFire/explosion/hot materialOTHERMaterials16. Prime Cause (Tick one CATEGORY and one Type relevant to that Category.)PLANT / EQUIPMENTPPEHUMAN FACTORSWORK ENVIRONMENTConstruction/designDesignFailure to follow rulesDefective workplaceInstallationWrong type usedInstructions misunderstoodPoor housek
12、eepingSafety deviceMaintenanceError of judgementLightingOperation/useNot provided/unavailableLack of experienceWeatherMechanical failureNot usedUnsafe attitudeDesign/LayoutMaintenanceUndue hasteLack of roomMANAGEMENTHorseplayNoise/DistractionSystem of workFatigueSupervisionWorking without authorisat
13、ionOTHERTrainingThird PartyCommunicationOther (specify)17. Potential Matrix Factor & Investigation LevelCost - 1k1-10k10-100k100k-1M1M+No. of people at risk012-1011-100101+InjuryLossEnvironment111222First Aid Negligible Injury; No absence from workMinor loss/damage/ business impactMinimal reversible environmental impact211
