APEX GLOBAL ENGINEERING SDN BHD (828911-T)

Attachment XVII
ACCIDENT CONTROL TECHNIQUE FORM

Target Date Submitted by

No Date What Why Location Description Action Status
of Resolve Rank / Name

Vessel name

Note: 1 copy to be sent to onshore office electronically.

 APEX GLOBAL ENGINEERING SDN BHD (828911-T)

WHAT hazardous act / condition did WHAT hazardous act / condition did
you see? you see?
PPE
1 Head Protection not worn 46 Permit procedure not followed
2 Eye Protection not worn 47 Deviate from procedure
3 Face Protection not worn 48 Others (please specify)
4 Ear Protection not worn
5 Protection clothing not worn
6 Safety Shoes not worn
7 Hand Protection not worn
8 PPE in bad condition
9 Wrong PPE for the job WHY did the hazardous act /
10 Substandard PPE condition occur?
11 Others (please specify)
NOT AWARE
TOOLS / EQUIPMENT
12 Wrong tool for the job A) Not informed
13 Tools in bad condition B) Language problem
14 Tools not inspected C) Not reading the permit
15 Tools not used correctly D) Wrong Interpretation of the risk
16 Not Correctly installed E) Wrong instruction
17 Others (please specify) F) No procedure
G) Forgotten
MATERIAL HANDLING H) Do not know
18 Too heavy for manual lifting I) Others (Please specify)
19 Wrong mechanical manual lifting
20 Lifting tool not inspected AWARE
21 Chemicals not properly handled
22 Others (please specify) K) Negligence
L) Working Condition
POSITION / REACTIONS OF PEOPLE (Including weather)
23 In danger of struck by …… M) Worksite Layout
24 In danger of striking against N) The design of equipment / tools
25 In danger of caught by O) Work habits
26 In danger of fall / slip / trip P) Lack of skills
27 In danger of burnt / frozen Q) Time pressure
28 Wrong position R) Not requested
29 In danger of electricity S) Physical Limitations
30 In danger of felling overboard T) Not supplied / available
31 Others (please specify) U) Lack of ownership
V) Confused
HOUSEKEEPING W) Others (please specify)
32 Access block by obstruction
33 Tools / materials disorganized
34 Poor / Improper roping off DEFINITIONS
35 Accumulation of rubbish Unsafe Act:
36 Others (please specify)
Action that increases chances of injury, breaks
ENVIRONMENT established safety Rules or is against expected conduct
37 Water is being polluted
38 Air being polluted Unsafe Condition
39 Too Much noise
40 Spillage of oil / chemical Situation directly or indirectly caused by the ACTION or
41 Others (please specify) INACTION of one or more workers that may lead to an
accident
PERMIT / PROCEDURES
42 Work without permission
Positive Card
43 Wrong permit
44 Procedure not followed
An act that shows commitment to HSE or reduces the
45 Wrong instruction on permit
risk of accidents/ incidents. (What and Why columns
should be left empty)
NOTE: To be retained on board.