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Consequence Type
Basic Info
Injury
Dropped Objects
Witness
Attachment
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Consequence Type
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Injury
Dropped Objects
Witness
CONTRACTOR Involved
Fire
Material Release
Crane/Heavy Equipment
Property Damage
Motor Vehicles
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Basic Info
Incident Date
Incident Time
Select Zone
Zone 01
Zone 02
Zone 03
Select Activity
Trench Evacuation
Drilling Operation
Riser Handling Crane
BOP Skid Handeling
Observation
Hazardous Event
Near Miss
Accident
Select Severity
Minor
Moderate
Critical
Catastrophic
Select Type
Physical Hazards
Incident Subject
Incident Description
Immediate Safeguard Actions Taken
Shutdown Time
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Injury
Total Workers Invloved
1
2
3
1st Worker Details
Select Worker Involved (Name or ID)
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Injury Type
Amputation
Brain Damage
Bruising, Grazes, Bites
Burns - Chemical
more...
Nature of Injury
Cuts and lacerations
Sprains and strains
Punctures
Burns
more...
Incident Description
Select Body Parts
2nd Worker Details
Select Worker Involved (Name or ID)
Select
Injury Type
Amputation
Brain Damage
Bruising, Grazes, Bites
Burns - Chemical
more...
Nature of Injury
Cuts and lacerations
Sprains and strains
Punctures
Burns
more...
Incident Description
Select Body Parts
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Dropped Objects
Total Tools Invloved
1
2
3
01
Tools Involved
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Tools Belong to
contractor
Object Weight
in
Kilograms
Distance of Falling
in
Meters
Remark
02
Tools Involved
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Tools Belong to
contractor
Object Weight
in
Kilograms
Distance of Falling
in
Meters
Remark
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Witness
Select Worker Witness
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Attachment
UPLOAD
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