INCIDENT NOTIFICATION & INVESTIGATION REPORT
PART 1 : NOTIFICATION
Report Date: 22 Mac 2013 Report No: SSSB/INIR/01/2013
Project: AFC Chemical Cleaning PDH TA 2013 Name of Reporter: Mohd Rizal @ Azizan b. Mohd Salleh
Regulatory Reportable Yes No Event Date: 20 Mac 2013 Event Time: Approx. 0400 PM
DESCRIPTION OF ACTUAL OR POTENTIAL LOSS
Site: Injury and Environmental: Vehicle: Other: Severity
PDH AFC
Illness: Classification:
CHEMICAL
Fatality Spill Leak Light Vehicle Property/Equipment Catastrophic
CLEANING
FACILITY Medical Air Emission Heavy Vehicle Security Major
First Aid Waste Water Discharge Reputation Serious
Shocked Regulatory Violation Light
Near Miss
Brief Description: Xylenes Spillage Incident Occurred At AFC Chemical Cleaning Facility
Description of Facts (Who, What, Where, When, Why?):
Who- Truck driver from Pengangkutan Cogent Sdn Bhd, name Manikram a/l Powlasamy, i/c number 660223-05-5265
been assign to bring Xylens Chemical to PDH and transfer the chemical by using vacuum engine into the circulation
tank assisting by Disya Operation Team.
What- Xylenes spillage incident occurred at AFC chemical cleaning facility during loading activity into skid tank from chemical truck.
Estimated of 100 liter xylenes have been spilled out at the left side of the truck into the road and drainage. The quick response
has been made by truck driver to switch off the engine and Disya Operation to close the tanker valve. After indentifying the
spillage location, the operation team has clear out the spillage by using cotton rags and put the contaminated rags into the
scheduled waste drum. Exterminated 3 gunny of rags been use to absorb the spillage chemical. After that water and detergent
soap been use to dilute the spillage chemical. After 2 hours the area has been clear again by using saw dust.
Where- PDH AFC chemical cleaning facility area
When- 20 Mac 2013, event time approximately 0400 PM
Why- The spillage was due to improper tighten of the end cap at chemical manifold located on the chemical truck during chemical
transfer activity
Risk Classification:
Step 1: Mark on the matrix the frequency of the Job Task from Very Low to Very Step 2: Assign Risk classification:
High, and the Worst Probable Severity from Light to Catastrophic. The Risk
Classification (H, M or L) will result:
Very High (performed daily or weekly at site) High: (Do not take this risk)
Frequency of job task
High (performed monthly at site) Medium: (Reduce this risk) x
Medium (performed less than annually at site) x Low: (Improve)
Low (performed less than annually at site)
Very Low (never performed before at site)
Light Ser Major Cata
Worst Probable Severity
Names/ Name(s) of Injured: N/A Signed:
Signatures: CEO: Andansura b. Rabu Signed:
HSE Representative: Mohd Rizal @ Azizan b. Mohd Salleh Signed:
Project Engineer : Mohd Azrul Aminur b. Ismail Signed:
NB: Unless classified as Light with Low Potential, all incidents must be taken to part 2 investigations.
Page 1 0f 3
INCIDENT NOTIFICATION & INVESTIGATION REPORT
PART 2 : CAUSE INVESTIGATION (SCAT)
Attach sketch, photographs, witness statements, additional information as required.
Investigation Section 1 – Type & Immediate/Direct Cause?
Type of
Event: Struck against Caught on Overstress/ergono
Struck by Caught between or under Equipment failure
Fall to lower level Spill leak Contact with
Fall to same level Abnormal operation Other:
Caught in Product contamination
Substandard Operating equip w/o authority
Acts: Failure to check/monitor Failure to react/correct Horseplay
Operating at improper speed Improper position for task Improper loading
Making safety devices inoperable Servicing equip in operation Failure to secure
Using defective equipment Failure identify hazard/risk Failure to warn
Failure to use PPE properly Under influence of alcoh/drugs Improper lifting
Failure to communicate/co-ord Using equipment improperly Improper placemen
Failure to follow procedures Other:
Substandard Inadequate guards or barriers
Conditions: Inadequate/improper protect equip Inadequate information/data Noise exposure
Defective tools, equip or material Inadequate communications Radiation exposure
Congestion or restricted action Temperatures extremes Scaffolding conditio
Inadequate warning system Inadequate ventilation Weather conditions
Fire and explosion hazard Presences of harmful materials Other:
Poor housekeeping/disorder Inadequate installation of canvas
Inadequate/excess illumination
Investigation Section 2 – Basic/Root Cause?
Personal Factors: Job Factors:
Inadq physical capability Lack of skills Inadq leardership/supv Inadq work standard
Inadq mental capability Physical stress Inadq engineering Inadq communications
Improper motivation Abuse or misuse Inadq purchasing Inadq tool and equip
Mental stress Other: Inadq maintenance Other:
Lack of knowledge Excessive wear and tear
Investigation Section 3 – Areas for Corrective Action
Leadership and admin Task obsrvation Rules and work permits Material & services mgt
Leadership training Incident analysis Skill training Off-the-job safety
Inspections& maintenance Quality mgt Health/hygiene control General promotion
Critical task analysis&proc Enviromental mgt System evaluation Other:
Hiring and placement Engineering mgt Personal communications
Emergency preparedness PPE Group communications
Page 2 of 3
INCIDENT NOTIFICATION & INVESTIGATION REPORT
PART 2 : CAUSE INVESTIGATION (Cont…)
Attach sketch, photographs, witness statements, additional information as required
Investigation Section 4 – Corrective action
Ite
Person Completion
m Action Item Target Date Remarks
Responsible Date
No
1
Properly tighten connection fittings Syamiras
20/01/2013 20/01/2013
Operation
Diaphragm pump test run using water
Syamiras
2 as medium 20/01/2013 20/01/2013
Operation
3
To provide container & canvas spillage Syamiras 20/01/2013 20/01/2013
Operation
4 Pump inspection PDH 20/01/2013 20/01/2013
Syamiras
5 To provide spill kit Operation
20/01/2013 20/01/2013
MSDS for all chemical (xylene,
6 Syamiras HSE 20/01/2013 20/01/2013
toulene, FSol 500)
Chemical handling briefing prior
7 Syamiras HSE 20/01/2013 20/01/2013
loading activity
Investigation section 5 – Comments by Reviewing Line Manager
Name(s)/Signature(s):
Attachment(s)
Items Being Continued: Notes:
Witness Statements Yes No
Sketch Yes No
Additional Explanation Yes No
Photograph Yes No
Other Yes No
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