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AE
ACE
E INTEG
GRATED
D MANA
AGEMEN
NT SYS
STEM
HS
SE PRO
OCEDUR
RE AHP//01
HE
EALTH, SAFETY
Y AND ENVIRO
ONMENTAL RE
EPORTING
Issue
e 1, Rev
v. 02, 20
0 March 2012
THIS
S IS AN IM
MS LEVEL 3 DOCUM
MENT
ACE INTE
EGRATED MANAGEMEN
M NT SYSTEM M
HSE PROCEDURE AHHP01 – Issue 1, Rev. 02
2, 20 March 2012
2
HEALTH, SAFETY AN
ND ENVIRON NMENTAL R REPORTING G
REVISION HIST
TORY
1 0
02 20 Ma
arch 2012 Minor
M formattting GH DJ ZH
1 0
01 29th January
J Amendment
A to include HSE
H GH DJ ZH
2
2012 Statistical
S rep
porting
1 0
00 Janua
ary 2012 First
F issue GH DJ ZH
Issue ev.
Re Date Description
D o
of revision Prepared
d Checked
d Authorizzed
Tab
ble of Conte
ents
1. PURP POSE AND SCOPE ......................................................................................................................................... 4
2. TERM MS AND DEF FINITIONS ................................................................................................................................. 4
2.1 ACCIDENT .............................................................................................................................................................. 4
2.2 INCCIDENT/NEAR MISS ............................................................................................................................................ 4
2.3 DAANGEROUS OCC CURRENCE .................................................................................................................................... 4
2.4 ILLL HEALTH ........................................................................................................................................................... 4
2.5 OCCCUPATIONAL ILLNESSES .................................................................................................................................... 4
2.6 LOST TIME INJUR RY (LTI) ........................................................................................................................................ 5
2.7 MA AJOR INJURY ....................................................................................................................................................... 5
2.8 FATTALITY ............................................................................................................................................................... 5
2.9 REPPORTABLE INJJURY ............................................................................................................................................. 5
2.10 REC CORDABLE INJURY OR ILLNESSES ..................................................................................................................... 5
2.11 SER RIOUS HSE INCIDENTN ......................................................................................................................................... 5
2.12 IMM MEDIATE CAU USE................................................................................................................................................. 5
2.13 ROOT CAUSE .......................................................................................................................................................... 6
2.14 SITTE........................................................................................................................................................................ 6
2.15 WO ORK-RELATED D .................................................................................................................................................... 6
2.16 MEEDICAL TREATTMENT ........................................................................................................................................... 6
2.17 FIR RST AID ............................................................................................................................................................... 6
2.18 POLLLUTION INCID DENT – MINOR R............................................................................................................................. 6
2.19 POLLLUTION INCID DENT - MODER RATE ...................................................................................................................... 6
2.20 POLLLUTION INCID DENT – MAJOR R ............................................................................................................................ 7
2.21 AB BU DHABI EHS SMS .............................................................................................................................................. 7
2.22 SEC CTOR REGULA ATORY AUTHO ORITY - (SRA) ........................................................................................................ 7
3. REFE ERENCES ......................................................................................................................................................... 7
4. PROC CEDURE ........................................................................................................................................................... 8
4.1 ACCCIDENT, INCID DENT, INJURY, ILL HEALTH A AND NEAR MISS INVESTIGA ATION ................................................... 8
4.2 ACCCIDENT, INCID DENT, INJURY, ILL HEALTH A AND NEAR MISS REPORTING ........................................................ 10
4.3 CORPORATE REPPORTING AND REPORTING TO O ACE............................................................................................ 11
4.4 NOON-CONFORMA ANCE, CORREC CTIVE AND PRE EVENTIVE ACTION ......................................................................... 12
4.5 ABBU DHABI EHS SMS REPORTIN NG TO SECTOR R REGULATOR RY AUTHORITY Y (ABU DHABII ONLY) ........................ 13
4.6 RESSPONSIBILITIEES ................................................................................................................................................ 14
4.6.1 H
Health, Safetyy and Environm mental Deparrtment ............................................................................................. 14
4.6.2 P
Project / HSE E Advisors/ Off ffice Manager ...................................................................................................... 14
4.6.3 Managers / Suupervisors ............................ ...................................................................................................... 14
M
4.6.4 H
Health, Safetyy and Environm mental Managger ................................................................................................. 14
4.6.5 O
Office Safety Representative
R es .................. ...................................................................................................... 14
4.6.6 All ACE emplooyees ................................... ...................................................................................................... 15
A
5. RECO ORDS .............................................................................................................................................................. 15
6. APPE ENDICES ........................................................................................................................................................ 15
7. ASSO OCIATED FO ORMS ......................................................................................................................................... 15
A
APPENDIX 1: Protocol forr Actions folloowing an ACE E Accident / In ncident at Worrk ................................. 16
A
APPENDIX 2: Abu Dhabi External Repoorting Protoco ol .............................................................................. 17
APPENDIX 3: Dubai Exterrnal Reportingg Protocol ..................................................................................... 18
A
A
APPENDIX 4: Police and Labour L Minisstry Contact Details D ....................................................................... 19
APPENDIX 5: Root Causee Worksheet ... ...................................................................................................... 20
A
AHP011F/01 HSE Inccident Reportt ...................................................................................................... 25
AHP011F/02 Incident Investigationn Report......................................................................................... 26
AHP011F/03 Witnesss Statement Foorm ................................................................................................ 27
AHP011F/04 Annual Injury Statisti tics Report ...................................................................................... 28
AHP011F/05 Employyee Injury Stattistics Report.................................................................................. 29
2. TERM
MS AND DE
EFINITIONS
S
2.1 Accident
An un-plaanned even nt that resu
ults in injury
ry or ill hea
alth or dam
mage or losss to property plant /
materials or negative
ely impacts the environnment.
2.8 Fatality
Loss of liffe of any ACE employee, ACE su ubcontractoor personnel, client perrsonnel or member
m of
the generral public that can be perceived
p o be related to work perrformed or ccontrolled by
to b ACE.
Anny amputatiion.
Ho ospitalizatio
on for treattment (adm mission) forr more tha an 24 hourrs. Any wo ork-related
injjury/illness resulting in
n the absen nce from work
w for moore than 300 calendar days of a
sinngle emplo oyee. Any single
s workk-related ev vent resultinng in more than one employee
beeing absen nt from workw for more than 3 days s. Any H HSE-related consent
aggreement/orrder/citation n/lawsuit orr enforceme ent action seeking moore than $10,000 or
alleging crimiinal activity..
Anny spill or re
elease of a hazardous material tha at is reporta
able to a reggulatory ageency.
Anny Notice of o Violationn resulting ffrom failure
e to operatte within thhe requirem ments of a
goovernment permit
p or co
onsent. Neaar-miss inciddents that, ini the opinioon of the, UAE
U Board
off Directors, UAE Country Operattions Direc ctor, Quality y Assurancce Director, Regional
HS SE Manage er, may have otherwise e resulted inn any of the above.
mediate Cause
2.12 Imm
The mostt obvious re
eason why an
a unsafe e event/act oc ccurs, e.g. “g missing on machine”.
guard was m
There ma
ay be severa al immediatte causes id
dentified in any one adverse even t.
2.14 Site e
A site is the location of the incid may be an operational location, offfice or simila
dent. This m ar.
2.15 Worrk-Related
Arising frrom an exp
posure or oc
ccurrence o
on the emp ployer's pre
emises or oother locatio
ons where
employee es are eng
gaged in work-related
w d activities or are prresent as a condition n of their
employme ent.
2.16 Med
dical Treatmment
Treatmen
nt beyond firrst aid.
2.17 Firs
st Aid
Treatmennt using anyy of the follo
owing:
2.21 Abu
u Dhabi EH HSMS
Environm
mental Healtth and Safety Managem ment System and regu
ulatory fram
mework within the Abu
Dhabi Em
mirate as byy Decree 42 of 2009 of the Crown Prince.
3. REFE
ERENCES
Le
egal reportin
ng external protocol Du
ubai (Appen ndix 3)
Po
olice and Laabour Minis
stry Contactt details (Ap
ppendix 4)
Ro
oot Cause Worksheet
W (Appendix 5 5)
4. PROC
CEDURE
4.1 Accident, Incid dent, Injuryy, Ill Health and Near Miss
M Investigation
All work--related injjuries, illne
esses, and d near-miss situation ns must bbe docume ented and
investigatted as soon
n as possiblle. The long ger the dela
ay, the less likely it is tthat the true
e facts will
be ascerrtained. For major/serrious eventts the area a will be cordoned
c ooff until the
e police /
authorities complete their investtigation andd authorise re-entry.
nvestigation
Incident in n measures
s are as follo
ows:
a. Coord
dination with
h the Safety
y, Health an
nd Environm
mental Depa
artment
In accorddance with Emergenc cy Prepareddness and Response (AHP/02) and the Accident A &
Incident R
Reporting Protocols
P described in
n Appendice es 1 to 3 of
o this proccedure (AHP/01), the
Health, S
Safety and Environmen
E ntal Departm
ment will be s soon as p ractical and
e notified as d informed
of any faatalities, ma
ajor injuries
s, immedia te hospitalization or major
m envirronmental / property
damage, this will be e done by informing the ACE HSE H Manag ger and theen the HSE E Incident
Report (AAHP01F/01) will be completed
c and sent to t the Hea alth, Safetyy and Environmental
departmeent within 24hrs. The incident de etails will be
e logged, re ecorded annd maintained by the
ACE HSE E Manager.
b. Initial Investigatio
on
Any incident, near miss
m or ill he
ealth on site
e will be initiially investig
gated by thee responsib
ble Project
Manager or their authorised
a representattive e.g. Site
S HSE Advisor,
A Prroject Engineer, etc.
Assistancce in conducting an inc cident invesstigation maay be obtain ned from thhe Health, Safety
S and
Environmmental Depaartment. HS SE Incident Report (AH HP01F/01) will w be usedd to log dettails of the
incident.
c. Investtigation Doccumentation n
Fo or recordabble injuries, fatalities an
nd environmmental dama age, the forrmal investigation will
coommence as a soon as practical fo ollowing the
e incident and
a findinggs documennted using
Incident Inve estigation Report
R (AHHP01F/02). Specific contents aand details s of each
invvestigation will be reviewed by th he Health, Safety
S and Environmenntal Department. Any
wiitness state
ements take en will be reccorded on Witness
W Sta
atements Foorm (AHP01 1F/03).
Ro oot cause analysis
a tec
chniques w ill be used as part of the investiggation proce ess, using
Rooot Cause Worksheet
W (Appendix 5 5).
d. Investtigation Tecchniques
Usse sound in nvestigation techniquess, including the followin
ng:
- Begin n the investiigation as ssoon after the incident as practicaal. Take photographs
of thee incident and surround ding areas to ensure that
t we cann preserve the scene
for the
e investigation.
- Walk around, loo ok at everytthing, use all
a of your senses
s i.e. sight heariing, smell,
feelinggs / intuition
n.
- Recon nstruct and document the event leading up to the inciddent as acc curately as
possibble.
- Conduct all interrviews one--on-one, in private, annd use “opeen-ended” questions.
q
The interviewee e has the right to haveh someoone in atte tendance during
d the
interview.
- Make the goal ofo the investtigation to determine
d the
t root cauuse of inciddents, and
NOT tot place bla
ame on a paarticular individual.
- Identify the rooot cause oof the incid dent in ord der to deteermine the e possible
requirrement to ch
hange “systtems,” not only
o the con
nditions or aactions.
Required Data
Ga
ather the foollowing data a (where ap
pplicable to the incidennt):
- Backg ground data a concerninng the inciddent derived d from supeervisor’s re
eports and
persoonal intervie ews with em mployees, response pe ersonnel, annd other paarties who
were either invo olved in thhe incident or witnessed its occcurrence. This data
includdes the time e, date, loca
ation, operaation, or equuipment invvolved in the
e incident,
as well as pers sonal inforrmation on employee(s) involveed. This will include
immediate cause es and seco ondary caus ses.
- Equip pment inform mation inclu
uding make e, model, ty ype, size, ccustom mod difications,
curren nt condition, and its se rvice history
y.
- Activitty at the tim me of the e event indicaating the ge eneral job ttask being performed
(e.g., pump repair) and speccific activity y (e.g. using spanner).
- Work shift inform mation such h as shift tim
me (e.g. daay, evening , midnight),, length of
shift, breaks, any incident handover information that was ccommunicatted during
chang ge of shift.
- General preventtive controll measures s that were e in place at the tim me of the
incideent, including: persona e equipmentt worn, empployee training for the
al protective
task being
b perforrmed, and ssupervision present.
- Main Contractorr Method sstatement / Risk asse essment (ass applicable) for the
activitty including the environnmental risk k assessme ent.
- Weath her conditioons that ma ay have con ntributed to the incidennt such as heat, rain,
strongg winds, etc c.
- HR he ealth / mediical recordss of the partticular employee involvved.
e. Distrib
bution of Co
ompleted In
nvestigation Results
Copies off completed
d investigation reports w
will be distributed as de
escribed beelow:
All Investigations
- Copie es of the coompleted in nvestigation
n reports will be mainttained by th he Health,
Safetyy and Environmental D Department..
erious Incidents
Se
- Depending on th he seriousneess of the incident, a copy
c of the report will be sent to
the Chief
C Execuutive Officerr UAE Boa ard of Direcctors, UAE Country Operations
O
Directtor, and anny External Legal Authority / Representativve as neces ssary and
requirred. (See in
nternal / exxternal repo
orting protocol appenddices for the e different
regionns in the Middle East, A
Appendices s 1 to 3).
Co
orrective Acctions
- Upon completion n of the innvestigation n, the Site HSE Manaager and or o Advisor
and/oor Project Manager will implementt procedures s to prevennt reoccurrence of the
incide
ent. Accep ptable corrrective actio ons includee re-traininng all employees as
neede ed, modifyinng work pra actices, installing equipment to aalleviate the
e situation,
and using person nal protectivve equipme ent.
- Unaccceptable actions incl ude retalia ation and stating
s thaat the accident was
unavooidable. Em mployee co ounselling (verbal discussions with the employee
conceerning wilfull and/or una acceptable acts that leed to the acccident) are permitted
only if
i written reecords are maintained d for such counsellingg and plac ced in the
emplooyee’s file. All
A correctivve actions will
w be close ed out in a suitable tim
meframe in
accorrdance with Site Inspecctions and Audits (AHP/10). This will be monitored by
the Heealth, Safetty and Envirronmental Department
D t.
4.2 Accident, Incid dent, Injuryy, Ill Health and Near Miss
M Reporting
The follow wing respo
onse proced dures will bbe followed
d in the ev
vent of anyy work-relatted injury,
illness, orr near miss occurring at
a an ACE lo ocation:
a. Injury / Illness invvolving ACE E Personne el
Afffected Emp ployee
- Each injured / siick employe ee must no otify his/her supervisorr immediate ely that an
incideent has occ curred, the circumstances involve ed, the natuure and exttent of the
injurie
es/illness, and
a whethe er medical treatment may be reequired. Except E for
emerg gency aid, affected e employees will follow w the Supeervisor’s in nstructions
conce erning obtaining mediccal treatmen nt. First aid treatment m must be souught for all
injurie
es, howeverr minor.
- HSE Incident Report (AHP P01F/01) will
w be comp pleted to innclude deta ails of the
injured person an nd the natuure of the incident and injuries susstained. The e form will
be sent to the He ealth, Safetyy and Envirronmental Department.
D .
Su upervisors
- The Supervisor
S must
m immeddiately inforrm their Prooject Managger that an event has
occurrred: The Supervisor w will assist in
n any investtigation carrried out folllowing the
incideent to prevent a recurreence.
Prroject Mana ager /Office Manager
- Revie ew the accid dent/ incide
ent, inform and
a report details
d to thhe Health, Safety
S and
Enviroonmental Department a as necessa ary.
He ealth, Safetty and Envirronmental M Manager
- Revie ew details of o the acciddent / incideent and dec cide upon aany further course of
actionn necessary y to prevennt a recurrence, this maym include further inve estigation,
revieww of procedures etc.
En nvironmenta al Incident Reporting
R
- Where e contracteed to do so,, ACE shall help to ma anage the ssite to ensu ure that no
enviroonmental in ncidents occcur, but in the unlikely event thhat an environmental
incideent does oc ccur HSE In ncident Rep port (AHP01 1F/01) will bbe used to report the
enviroonmental in ncident. Thiss follows thhe same prrotocols forr reporting as a section
4.2. This
T reportin
ng structure
e shall ensu ure that swifft action is ttaken to min
nimise the
impacct of such an incident a and that eve eryone is fully aware of what has happened
Page 10 of 29
9 For Internal Use Only
ACE INTE
EGRATED MANAGEMEN
M NT SYSTEM M
HSE PROCEDURE AHHP01 – Issue 1, Rev. 02
2, 20 March 2012
2
HEALTH, SAFETY AN
ND ENVIRON NMENTAL R REPORTING G
and how
h it is to be mitiggated. The
e reporting structure will ensuree that all
enviro
onmental incidents a are investiigated andd any chaanges to operating
proce
edures that are requiired are ca arried out. Any Cliennts/Main Contractors
reportting proceddure shall ssupplementt the ACE reporting pprotocol described in
sectio
on 4.2 of this
s proceduree.
4.3 Corp porate Reporting and Reporting g to ACE
All ACE rrecordable injuries
i d to ACE Corporate
will be reported C on the day oof the eventt. All other
injuries, e
events, houurs worked will be reco n 4 days off financial cclose of each month.
orded within
ACE reco ordable inju
uries are deefined in ACCE Injury & Illness Reecord-keepiing Require ements as
outlined bbelow:
All Emplooyee/ Contractor Fata ality HSE Inncidents will be reporrted by thee Health, Safety
S and
Environmmental Mana ager immed diately to th
he UAE Board of Dire ectors, UAE E Country Operations
O
Director, Chief Execcutive Office
er and Execcutive Manaagement Te eam, immeddiately eitheer verbally
or by em mail. A Siggnificant HSSE Initial I ncident Re
eport detailing the inccident mus st also be
submittedd by either email
e or other acceptedd media witthin 24 hourrs after the eevent.
All Majorr HSE Incid dents will be
b reportedd immediattely to the UAE Boarrd of Directtors, UAE
Country Operationss Director, Chief Exe ecutive Offficer and Executive
E Manageme ent Team,
immediate ely either verbally
v or by email. A Significan
nt HSE Initiial Incident Report deetailing the
incident m
must also beb submitted by eitherr email or other
o accepted media w within 24 hours
h after
the eventt.
A final invvestigation report
r will be
b issued to
o the UAE Board
B of Dire
ectors, UAE
E Country Operations
O
Director, Chief Exe ecutive Offic cer and Exxecutive Managemen
M t Team wiithin 5 dayys, unless
external e extenuating circumstan nt this deadline from be
nces preven eing met.
In addition to the above, All Acccidents, Inciddents, Near Misses and Dangerous
D OOccurrences throughout
ACE are too be reportedd to the Health, Safety annd Environm
mental Manag
ger as outlineed below:
Monthly rreporting off HSE statiistical data is to be collated and d submittedd to the AC CE Health,
Safety annd Environmmental Mana ager utilisin
ng form AHP P01F/05 Em mployee Inj ury Statistic
cs Report,
this form is used by nominated
n project staff
ff to submit statistical data on a prroject by pro
oject basis
as outline
ed by the HSE Manage er for his annalysis, collation and subsequent submission n following
the accepptance of the Quality Director to o the ACE Country
C Opperations DDirector andd the ACE
Chief Exeecutive Officcer.
Annual re eporting of HSE statis stical data is to be co ollated and submitted by the AC CE Health,
Safety an nd Environmmental Man nager utilisi ng form AHP01F/04
A Annual Injuury Statistic cs Report,
this form is used by b the HSE E Manager to submit the annual collated aand cumula ative HSE
statistical data from the
t monthly y submissio ons by nomiinated ACE E staff, utilis ing form, AHP01F/05
Employee e Injury Statistics Repo
ort as outlin
ned above for
f further submission bby the HSE E Manager
following the accepta ance of the Quality Dirrector to the
e ACE Coun ntry Operattions Directo or and the
ACE Chie ef Executive
e Officer.
Page 11 of 29
9 For Internal Use Only
ACE INTE
EGRATED MANAGEMEN
M NT SYSTEM M
HSE PROCEDURE AHHP01 – Issue 1, Rev. 02
2, 20 March 2012
2
HEALTH, SAFETY AN
ND ENVIRON NMENTAL R REPORTING G
Annually
4.4 Non--Conforma ance, Correective and P Preventive Action
The first e
essential stage in the control
c of a ctual or pottential non-cconformancce is to reco ognise the
problem. Therefore, a key requ uirement of the training g of all interrnal person nel is the re
ecognition
of non-coonformance in the HSE Manageme ent System and related d controls.
Problemss can occu ur at any level in an ny disciplin
ne or functtion. Thereefore, reporrting non-
conformaance is a shared
s resp
ponsibility o
of all Perssonnel. Mannagers andd Superviso ors in the
respective
e area are responsiblle for takin g immediatte action (c corrective aaction) to control
c the
effects off actual noon-conforma ance, and initiating thhe action (p
preventive action) to reduce or
eliminate the risk of potential
p no
on-conforma ance.
Projects / Site Mana agers and Supervisors
S s coordinatee and recorrd non-confformance in
nformation
to assist the solution of proble
ems. Each person res sponsible foor reporting non-compliance will
record onn the ACE E NCR forrm quality forms available, othe er approveed forms (ee.g. client
requiremeent) or the HSE
H Audit Checklist
C w ith essentia
al informatio
on, includingg:
Deepartment where
w the problem
p occcurred
Daate
Deescription of
o the probleem
Initial corrective action ta
aken
Signature of the
t Manage er / Supervi sor
Page 12 of 29
9 For Internal Use Only
ACE INTE
EGRATED MANAGEMEN
M NT SYSTEM M
HSE PROCEDURE AHHP01 – Issue 1, Rev. 02
2, 20 March 2012
2
HEALTH, SAFETY AN
ND ENVIRON NMENTAL R REPORTING G
4.5 Abu Dhabi EHS SMS Reporrting to Sec ctor Regula atory Authority (Abu Dhabi onlyy)
Third party auditingg of the HSE H Mana gement Sy ystem is a requiremeent of the EHSMS.
Submissioon of the 3rd
3 party re eport to the SRA will be
b complete ed and subbmitted on an annual
basis usin
ng the Entityy External EHSMS
E Aud
dit Report (EHSMS Fo orm F).
The follow
wing incide ed verbally and in writing using Entity EHS
ents are to be reporte S Incident
Report (EEHSMS Forrm G) to thee SRA as so
oon as praccticable afte
er the eventt:
Fa
atality
Re
eportable Serious
S Injurry
Major Pollutio
on Incident
The follow
wing incidents are to be
b recorded
d at the time
e of the eve
ent and repported as in
ndicated in
the table below:
Ne
ear miss inccidents
Minor pollutio
on incidents
s
Medical treattment case
Re
estricted duuties case
E
EHSMS
C
Calculation
n Freequency of reporting
g
perforrmance KP
PI
The tootal number of Lost Tim
me Injuries per
p
Lost Tim
me Injury Quaarterly
million hours workked during the
t period.
Frequency Enttity EHSMS Statement
No. of LTI’s x 1,00
00,000 /
Rate (L
LTIFR) (Foorm E)
Workin
ng Hours
The tootal number of lost Worrkdays per
Lost Tim
me Injury Quaarterly
million hours of w
working.
Severityy Enttity EHSMS Statement
No of Days
D Lost x 1,000,000
0/
Rate (L
LTISR) (Foorm E)
Workin
ng Hours
Total R
Reportable The nuumber of tottal reportab
ble cases pe
er Quaarterly
Case million man hourss worked. Enttity EHSMS Statement
Frequency (TRCF)) TRC x 1,000,000 / Working Hours
H (Foorm E)
Quaarterly
Total number
n of re
reportable in
ncidents in the
t
Pollutio
on incidents Enttity EHSMS Statement
period
(Foorm E)
Page 13 of 29
9 For Internal Use Only
ACE INTE
EGRATED MANAGEMEN
M NT SYSTEM M
HSE PROCEDURE AHHP01 – Issue 1, Rev. 02
2, 20 March 2012
2
HEALTH, SAFETY AN
ND ENVIRON NMENTAL R REPORTING G
4.6 Resp
ponsibilitie
es
4.6.1 He
ealth, Safetty and Envirronmental D
Departmentt
To
o assist with
h any incideent investiga ation when requested
En
nsure the incident inv vestigation procedure e is being followed aand is avaiilable and
co
ommunicate ed at point of
o use
Re
eview forma al investigattion reportss
Lo
og incident details
d into ACE Recod ding Mechaanism.
4.6.4 He
ealth, Safetty and Envirronmental M
Manager
Reeviewing all reports annd documen ny work-relaated injury, illness, or
ntation perttinent to an
ne
ear miss invvolving any ACE emplo oyees. Com mpilation of Safety
S statisstical analys
sis, etc.
Reeporting fa
atalities andd/or major injury cas ses to the e Chief Exxecutive Offficer and
Exxecutive Maanagement Team
Cooordinates investigatio
on of non-coonformance
Reecords and communica ates decisio
ons on correective and preventive
p aaction
Page 14 of 29
9 For Internal Use Only
ACE INTE
EGRATED MANAGEMEN
M NT SYSTEM M
HSE PROCEDURE AHHP01 – Issue 1, Rev. 02
2, 20 March 2012
2
HEALTH, SAFETY AN
ND ENVIRON NMENTAL R REPORTING G
5. RECO
ORDS
HSSE Incidentt Report (AH HP01F/01)
Incident Invesstigation Re eport (AHP001F/02)
W
Witness State ement Form m (AHP01F//03)
Annnual Injuryy Statistics Report
R (AHP
P01F/04)
Emmployee Injury Statistic cs Report (A
AHP01F/055)
HSSE Audit Ch hecklist (AH
HP/10F/06)
ACCE Non-Co onformance Reports (N NCR)
All and any corresponde ence with a Regulatory
y Authority
6. APPE
ENDICES
Ap
ppendix 1 Internal Repo ocol following an ACE A
orting Proto Accident / In
ncident at
Work
W
Ap
ppendix 2 Ab
bu Dhabi Exxternal Rep
porting Proto
ocol
Ap
ppendix 3 Du
ubai Extern
nal Reporting Protocol
Ap
ppendix 4 Po
olice and La
abour Minis
stry Contactt Details
Ap
ppendix 5 Ro
oot Cause W
Worksheet
7. ASSO
OCIATED FORMS
F
AHP
P01F/01 HSE
E Incident Report
R
AHP
P01F/02 Inciident Investtigation Rep
port
AHP
P01F/03 Witn
ness Statem
ment Form
AHP
P01F/04 Ann
nual Injury Statistics
S Re
eport
AHP
P01F/05 Em ployee Injury Statistics
s Report
Page 15 of 29
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EGRATED MANAGEMEN
M NT SYSTEM M
HSE PROCEDURE AHHP01 – Issue 1, Rev. 02
2, 20 March 2012
2
HEALTH, SAFETY AN
ND ENVIRON NMENTAL R REPORTING G
APP
PENDIX 1: Protocol for Actions
s following an ACE Ac
ccident / In
ncident at Work
W
Doc Special
Process
P
ref. Insttructions
Incidennt Occurs On
n
Site
Responsibilities
PM – Pro
oject Manager
No No No HSE Rep
presentative
Is it a Is it a Is it a
FIIRE Medical
M Minor
Emeergenc Em
mergenc Injury? PM to call emergency
services and
a report to
HSE Man nager and
Yes Yes Yes provide details of
incident.
Ca
all Complete Incidennt
Emerg
gency HSEE Incident Report
Serv
vices Repport Form Form
AH
HP01FO1
PM to com mplete
(99
99) AHP01 incident re
eport form
F/01 AHP01F/01 and send
to HSE Manager.
M
Send
d Monthly
Contac
ct ACE Repo
ort to HSE
HSSE Manager Monthlyy
Manager Report HSE Rep presentative to o
collate mo onthly injury
statistics and send to
HSE Man nager.
END
Page 16 of 29
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ACE INTE
EGRATED MANAGEMEN
M NT SYSTEM M
HSE PROCEDURE AHHP01 – Issue 1, Rev. 02
2, 20 March 2012
2
HEALTH, SAFETY AN
ND ENVIRON NMENTAL R REPORTING G
A
APPENDIX 2: Abu Dh
habi Extern
nal Reporting Protoco
ol
Special
S
Process Doc rref.
Ins
structions
No No No
ACE will
w report
Is itt a Is it a Is
s it a
accide
ent to the
FATAALIT Minor Minor
M
Y?? Inju
ury or In
njury? Police
e and
Ministtry of
Labouur.
Ca
all Inform Ministry of Follow ACE Projecct Manager
Emerg
gency Labour /Social Prootocol as to rep
port to HSE
Services Affairs
s within 24 in Appendix
A Mana ager following
(99
99) hours
h 1 intern
nal reporting
protoccol as in
Appendix 1.
Poliice
Policee will attend
Investiggation
site and conduct
La
abour investtigation,
Dep
partment
witnes ss
Investigation
statemments will be
record ded and a
policee report will
be isssued to
Labou ur dept. and
ACE Foormal
emplo oyer. ACE
Incident
will ke
eep a copy
Investigaation
of thee police
Report
Submmit Formal reportt.
AHP01F FO2
Investigationn report within 7
days to HSE Manager and
Ministrry of labour If an ACE
A
emplo oyee is
arrestted ACE will
inform
m the
relevaant embassy
of the
e employee
conce erned.
Page 17 of 29
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ACE INTE
EGRATED MANAGEMEN
M NT SYSTEM M
HSE PROCEDURE AHHP01 – Issue 1, Rev. 02
2, 20 March 2012
2
HEALTH, SAFETY AN
ND ENVIRON NMENTAL R REPORTING G
APPEND
DIX 3: Duba
ai External Reporting Protocol
Special
Process Do
oc ref.
Instructions
Incideent Occurs On
O Re
esponsibilities
Site
PM
M – Project
Ma
anager
No No No
IIs it a Is
s it a Fire Is it a
FA
ATALIT or Minor Fatality or seriouus
Y? Explosion
E Injury? ury
inju
necessitates
hosspitalization.
Call Follow
F ACE Prooject Managerr
Call Civil Defense
Emeergency Protocol
P as to report to HSE
Deppartment 997
Se
ervices in
n Appendix
Maanager followinng
((999) 1
inte
ernal reporting
g
pro
otocol as in
Apppendix 1.
Calll Dubai
Munnicipality Poolice will attend
d
site
e and conductt
inv
vestigation,
wittness
sta
atements will beb
reccorded and a
P
Police police report will
Inveestigation be issued to
Labour Dept. and
emmployer. ACE
will keep a copy of
the
e police reportt.
L
Labour
Deppartment
Inveestigation Labour dept. ma ay
decide to conducct
its own
vestigation or
inv
reqquest
Subbmit Formal suppplementary
Investigattion report within
n7 ACE Formal info
ormation.
HSE Manager and
days to H Incideent
Minisstry of labour Invesstigation
Repoort
AHP001FO2
END
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EGRATED MANAGEMEN
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HSE PROCEDURE AHHP01 – Issue 1, Rev. 02
2, 20 March 2012
2
HEALTH, SAFETY AN
ND ENVIRON NMENTAL R REPORTING G
AP
PPENDIX 4:: Police an
nd Labour Ministry Co
ontact Detaails
Khalidiya P
Police Station 02 6999999
Shabia Po
olice Station 02 6966666
Madina Po
olice Station 02 6985555
Police Ope
erator 2
04 269 2222
Departmen
nt of Eastern
n Region Police 02 370000
Al Heera P
Police Station
n 06 5241555
Buhairah P
Police Station 06 5564555
Zeid Police
e Station 06 8822222
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EGRATED MANAGEMEN
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HSE PROCEDURE AHHP01 – Issue 1, Rev. 02
2, 20 March 2012
2
HEALTH, SAFETY AN
ND ENVIRON NMENTAL R REPORTING G
Page 20 of 29
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ACE IN
NTEGRATED MA ANAGEMENT SYS STEM
HSE PR
ROCEDURE AHP P01 – Issue 1, Re
ev. 02, 20 March 2012
HEALTTH, SAFETY AND
D ENVIRONMENT TAL REPORTING G
Immed
diate Cause
System
m Causes Pers
sonal Factor
System
m Causes Job Factor
System
m Causes Job Factor
AHP01F/01
A 1 HSE Incid
dent Reporrt
Page 25 of 29
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ACE INTE
EGRATED MANAGEMEN
M NT SYSTEM M
HSE PROCEDURE AHHP01 – Issue 1, Rev. 02
2, 20 March 2012
2
HEALTH, SAFETY AN
ND ENVIRON NMENTAL R REPORTING G
Page 26 of 29
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ACE INTE
EGRATED MANAGEMEN
M NT SYSTEM M
HSE PROCEDURE AHHP01 – Issue 1, Rev. 02
2, 20 March 2012
2
HEALTH, SAFETY AN
ND ENVIRON NMENTAL R REPORTING G
AH
HP01F/03 W
Witness Sta
atement Fo
orm
Page 27 of 29
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ACE INTE
EGRATED MANAGEMEN
M NT SYSTEM M
HSE PROCEDURE AHHP01 – Issue 1, Rev. 02
2, 20 March 2012
2
HEALTH, SAFETY AN
ND ENVIRON NMENTAL R REPORTING G
AHP0
01F/04 Ann ual Injury Statistics
S Report
R
Page 28 of 29
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ACE INTE
EGRATED MANAGEMEN
M NT SYSTEM M
HSE PROCEDURE AHHP01 – Issue 1, Rev. 02
2, 20 March 2012
2
HEALTH, SAFETY AN
ND ENVIRON NMENTAL R REPORTING G
AHP01F/05 Emplo
oyee Injury
y Statistics Report
INJURY
Y
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