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ACCIDENT & INCIDENT REPORT

Date of Accident/Incident: 30-August-2021 Time: 7:00 AM

Principal Contractor: GENERAL AGENCIES

AND CONTRACTING
Contract #: PIC R-7505

Location of Accident/Incident: TAMA PS #1 Coordinates: T-10 FLOOD CHANNEL

HSE Manager: KHIZAR HAYAT Telephone: 0596191043

If this is an accident that required any form of medical treatment, go to Box 1:

If this indecent resulted in no person injured, go straight to Box 2:
Box 1 - Details of injured person N/A NO INJURIES RECORDED

Name: Age: Date of Birth:

Employer: Employed as:

Married / Single:
Nationality:

Injury sustained: Treated in Site First Aid Room or sent to Hospital:

(and mark on diagram below) (circle relevant)

Fatality First Aid Hospital Env-Incident

Iqama # Hospital Sent to:

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Box 2 - Property Damage only

Damage caused by:

Buried Services strike

RTA

Environmental

Theft

Other (give detail) DUMP TRUCK DRIVER CABIN DAMAGE

Box 3 - Equipment Involved

Vehicle Registration #: SUA 3107

Plant Serial #: RSO76WZZ1ED06536

Material Description: HYDRAULIC CYLINDER AND DRIVER CABIN DAMAGED

Box 4 - Other Companies involved & Authorities

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Company:

Contact #:

Box 5 - Accident / Incident Description

On the 30th of august at 6:00 AM, workers are preparing for the Pre task Briefing at the job
site prior to start of hauling activities and asphalt works. Usually 5 to 6 dump trucks are
hauling for asphalt and base course activity at site. Mr. Benedicto Agplaza one of the dump
truck drivers arrived at the working site for his first trip. He is working for PIC R 7505
project for 6 months and he is familiar with the site access and egress and working site.
When Mr. Benedicto Agplaza reach the dumping area he immediately unloaded a half load
of the base course material when suddenly the hydraulic cylinder snaps and had a failure
due to the load the dump box tilted to the left side and over turned the dump truck.

The driver and supervisor immediately called safety department and construction
management to report the incident. They claimed that it was due to hydraulic lifting cylinder
failed during unloading of the material. No injuries have been noted to the driver.

Box 6 - Immediate Causal Factor (refer to appendix 4)

Not following Procedures

Using incorrect or damaged tools / equipment

Safety Devices / guards not secure or removed, or PPE not used

Inattention, lack of awareness or poor decision / judgement

Horseplay / Violence

Guards or PPE did not work correctly

Defective tools or equipment

Environmental (fire, noise, temperature, chemicals, act of nature)

Workplace environment (electrics, lighting, ventilation, restricted space,

housekeeping)

Other – (give detail)

Box 7 - Contributory Causal Factor (refer to appendix 4)

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Physical capability / condition of person

Hazards not identified on risk assessment / method statement

Lack of knowledge / training

Conflicting instructions

Poor supervision / leadership

Poor sub-contractor

Poor engineering design

Poor planning / method statement

Poor materials used

Poor storage of materials / equipment

Poor tools / equipment used

No maintenance / servicing conducted on equipment

Policies & Procedures not enforced

Poor communication / no pre-task briefing

Other – (give detail)

Box 8 - Photographs

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Box 9 - Accident / incident sketch including critical dimensions

Box 10 - Other documentation attached to this report:

Witness Statements

Equipment Inspection records

Operator Licences

Risk Assessment

Method Statement

Pre-Task Briefing

Other Training Records

Any other relevant documentation

Box 11 – Actions Taken

Initial (at time of accident):

• Area was isolated with soft barricades
• No injuries were found during evaluation of the driver.
• RCSG has been informed.
• Legal authorities such as insurance and traffic police has been informed as well.
• Lifting plan and recovery plan was prepared and initiated to remove the dump truck at site.
• RA was done for lifting activity.
• Dump truck was removed from the site and sent to workshop.

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Remedial (to prevent accident / incident occurring again):

• Refresher training has been conducted for drivers and operators of dump trucks on how to use
daily equipment checklist.
• Equipment checklist must be routinely followed by operators, Equipment checklist was not specific
to the equipment and did not cover visual inspection of the hydraulic ram, Checklists to be updated
to be equipment specific.
• Regular maintenance of all equipment by mechanic & maintenance register maintained.
• Close supervision of supervisor and Driver/operator competency evaluation should be monitored.
(Register of Equipment & Operator to be maintained by company – this should include
MOT/Inspection Records, 3rd parties, Licenses and expiration dates.)
• Disciplinary actions upon noncompliance of daily equipment checklist and poor equipment
maintenance.
• RA and method statement was provided for specific job task. RA to be reviewed and updated to
ensure it covers Equipment maintenance and inspection.
• Equipment Inspection Record had expired, requires updating with workshop and transport
department.

Transport department has been informed to update all requirements regarding MOT such as
periodical inspection, registration and insurance of vehicle.

Box 12 – Lessons Learned (refer to appendix 4 findings)

The accident happened due to hydraulic jack failure. After further investigation The fitness report of truck
was found expired. The driver have KSA driving license but no third party training for operating dump box
hydraulic cylinder standard operating skills. Poor maintenance of the vehicle.

Box 13 - Details of person filling out this report

Name: Khizar hayat Contact Phone Number: 0596191043

Position: HSE MANAGER Contractor: GENERAL AGENCIES AND

CONTRACTING
Date: 30/AUGUST/2021 Time: 13:00 PM

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ATTACHEMENT

SAFETY TRAINING
SAFETY TRAINING FOR DRIVERS & OPERATORS
August 31, 2021

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LESSON LEARNED
30TH AUGUST 2021

Incident Type: Dump Truck Over Turn

Incident Summary and Discussion of Activities

On August 30, 2021 around 07:05 am, a GAC dump truck turned over on its side while dumping base
course material at Pump Station # 1 access road construction area.

The driver and supervisor reported that hydraulic cylinder jack of dump box was failed during
unloading material.

No injuries has been found.

Immediate and System Causes

• The driver act to dumping material perceived as a low risk activity.

• Fitness certificate for dump truck was expired.
• The dumping area was not well compacted and stable.
The driver have KSA valid driving license but no third party training for operating dumping
operations.

Corrective Actions/Recommendations

GAC immediate safety recommendations and actions taken are as follows:

• Provide spotter and supervisor for close monitoring.

• Conduct Safety Stand down for all drivers & site supervisors.
Equipment certification has been evaluated.

Contact Information
Engr. Khizar Hayat
Safety Manager
+966596191043
k.hayat@gacksa.com

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DRIVERS LICENSE AND MOT RECORDS

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 GENERAL AGENCIES & CONTRACTING (GAC)

Form No. RC/GAC/HSE/RA/003 GRADING, EXCAVATION, BACKFILLING RISK ASSESSMENT PROJECT: - PIC R-7505

Task: Construction of security fence. Update: 5/09/2021.

Assessed by: Mr. Charles Doria Reviewed By: Eng. .Khizar Hayat Approved By: RC

ACTION / GENERAL RISK / INITIAL RISK CONTROL MEASURES TO BE TAKEN RESIDUAL RISK
HAZARD SOURCE POTENTIAL RESPONSIBLE
CONSEQUENCES PERSON
Likelihood Initial Severit likelihood Residual
Severity Risk y risk
Factor factor

Site preparation & Poor Housekeeping (Slips and 1. Apply permit to work procedure to
Mobilization. trips) control the risk.
Arrangement of all Improper manual handling 2. Ensure all workers comply with PPE
3 4 12 2 2 4
required tools (Body pain & muscles strain policy.
Equipment and due to improper handling of 3. Install detour as par standard 1m away
safety items at work materials) from excavation edge and provide safety
site. signs.
Barricade the work Workers getting collided 4. Barricade the area of boom truck
site with Concrete hit/Run over by the boom 4 4 16 operation and only competent workers 3 2 6
new jersey using truck, other equipment, and by be allowed for load lifting operation.
boom truck. in coming vehicular traffic. Ensure the flagman deployed and the
traffic diverted. Competent operators
Loading/offloading, slip and and certified equipment to be used with Execution
falls, Snapping of load from proper supervision.
supervisor,
the boom truck (Personal 4 4 16 5. Use appropriate type of sling or chain for 1 2 2 Safety officer
injury/ fatality due to falling or lifting and discard the same if found
collision by the load being damaged and unsuitable for use. Out
lifted. riggers must be stowed in position
6. Thorough supervision and deploy
Physical injury to the worker if security guards.
they trip over equipment. 4 4 16 7. Provide necessary safety signs –Men at 2 2 4
work and lifting progress.

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 3 3 9 2 2 4

RESIDUAL
ACTION / GENERAL RISK / INITIAL RISK CONTROL MEASURES TO BE TAKEN RISK
HAZARD SOURCE POTENTIAL Initial Residual RESPONSIBLE
CONSEQUENCES Risk Severity Likelihood risk PERSON
Severity Likelihood
Factor factor

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Movements of Equipment and vehicle 1. Give way to the speeding vehicles on highway
equipment (Boom collision with incoming traffic. before entering.
Truck, Excavator, Equipment overturning or 2. Do not over speed; follow the traffic rules, signs
Dump truck. flipping over and signals displayed.
Personal injury 3. Exercise caution while maneuvering work in
4 4 16 progress area.
4. Install warning signs to alert the traffic about
the work in progress.
Heavy equipment always to be escorted while
5.
maneuvering on highway due to its speed 3 2 6 Job supervisor,
limitations. Operator,
Avoid sudden and harsh braking. driver.
6.
Competent and trained operator to be assigned.
7.
Operator and drivers to use roll over protection
8. system (Seat Belt).
Equipment operators wear appropriate PPE.
9.

1. Every piece of equipment that has safety

critical features must be inspected regularly.
The frequency of inspection, the ‘inspection
Equipment break Equipment overturning or schedule’, should be based on the risk
down/failure flipping over 4 4 16 assessment for the operation and use of the 3 2 6
Personal injury equipment.
Assessing the hydraulic fluid filtration system.
2.
Inspecting the hydraulic cylinder rod-here,
3.
you’ll want to look for any weaknesses, wear,
or stress. This inspection is crucial because a
bent or rough rod may damage the seals or
cause leakages.
Inspect the bolts and pins.
4.

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 Damage underground utilities 1. Apply PTW procedure and make sure utility
Grading clearance
Collapse of cavity walls
Excavation 2. Scan the area with utility detecting devices and
Backfilling Injury to workers-possibly marked.
Compaction. fatal 3. Coordinate with concern authorizes in case of
Physical injury to the worker if utility.
they Trip over equipment. 4. Follow the utility stakeholder instruction to deal
Equipment, material and with utility.
worker falling in excavated 5. Pre task briefing should be conducted and
area. explain work method statement and risk
assessment.
6. Tool box talk conducted before start of activity Execution team,
Suffocation and WRULD
4 4 16 and discuss hazard related to activity. 3 2 6 Safety officer
7. Where the services is in the vicinity of the
planned excavation, trail holes should be dug
by manually.
8. Mechanical excavators and power tools not
used within 0.5m of the indicated service lines
9. Exposed services protected with suitable
identical.
10. In case of shifting of utility must coordinate
with stakeholder.
11. Clear marked required area and escape from
both sides 1.6m away from excavation edges.
12. Make sure third party approved competent
person of excavation.
13. Make sure sloping as required.
14. If required makes benching as par standard.
15. Ensure the equipment maneuvering and
operating area is barricaded and 1.6m distance
from edges.
16. Certified equipment and competent operator is
assigned.
17. Damping of material 1.6m away from
excavation to avoid falling hazard.
18. Make sure gas test before start of activity.
19. Apply PTWC and control activities by applying
Safe system of work.

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20. Provision of banks man.
21. Apply dust control policy as mentioned in
Environmental plan.
22. Isolate workforce activity to plant operation.
23. Takes frequent breaks.

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 24. Make sure fresh drinking water igloos.

25. Provision of temporary facilities at site.

26. Emergency evacuation plan and emergency

contact number display at site locations.
Adverse Weather Heat stress, cold effects, 1. Provide clean and cold drinking water
conditions fatigue, respiratory illness, eye 2. Rest shelter to rest between rounds of work and
injury. toilet facilities.
4 4 16 Site
Vehicle and equipment 3. First aid Facilities and First aider.
2 2 4 management,
operational hazards 4. Appropriate and suitable PPE.
(Collision, overturn etc.). Safety officer
5. Stop all critical activities including confined
space and excavations. Resume after the
weather condition is conducive to work.
Use of Proper PPE
Injury to workers Spray regularly with water to keep the dust in control
Respiratory disease
Dust emission 3 3 09 2 2 4 Job supervisor,
Damage to equipment due to Safety officer
fine dust

1. Ensure right place for the right thing at

Site cleaning and Poor housekeeping sight at all times. Maintain the site good
grubbing. clean and tidy.
4 3 12 2 2 4
2. Clear all access and aggress, area should
Slip trip fall Execution
be clean and clear.
supervisor,
3. Avoid manual handlings use mechanical
Manual handling handling devices. If unavailable, follow
safe manual handling procedures.

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 Workforce gathering Comply with
Coronavirus Congested work area: In case a.Ministry of health instructions
COVID-19 to workers contact with each b.RC Technical Affair division & COVID-plan
other’s they may effected c.GAC COVID-19 prevention plan.
COVID-19. Prtial /complete .. Hand sanitizer available
illness and fatality.
.. Use face mask
.. Use disposable drinking cup one time.
.. Wash your hands many time a day.
.. Maintain social distance. All Execution
.. Save others to keep distance. team operators,
.. Temperature checking area Workforce etc.
4 4 16 2 2 4
• Keep safe distance from moving equipment and
lifting load.
Maintain social distancing.
• Avoid workforce gathering and make sure proper
social distancing.
• Ensure all workers comply with PPE policy
specially face mask + hand gloves.
• Provision of temperature checking devise.

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 1 2 3 4 5
Severity Matrix
1 1 2 3 4 5
1 - Very unlikely - Could happen but never in this construction field.
2 - Unlikely - Could happen but rarely. 2 2 4 6 8 10
3 - Possible - Could happen at some time. 4 - Likely - Could happen at any time.
5 - Very likely - Could happen frequently. 3 3 6 9 12 15

4 4 8 12 16 20

5 5 10 15 20 25

OCCURANCE PROBABILITY (O)

RISK ASSESSMENT
1 2 3 4 5
MATRIX
VERY
VERY UNLIKELY UNLIKELY POSSIBLE LIKELY 1-4 Low Risk
LIKELY
SEVERITY (S)

1 NEGLIGIBLE LOW LOW LOW LOW MEDIUM

5-9 Median Risk

2 MARGINAL LOW LOW MEDIUM MEDIUM MEDIUM

3 CRITICAL LOW MEDIUM MEDIUM MEDIUM HIGH

10-25 High Risk

4 SEVERE LOW MEDIUM MEDIUM HIGH HIGH

5 CATSTROPHIC MEDIUM MEDIUM HIGH HIGH HIGH

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