4-001 Incident Record

SAFE OPERATING PROCEDURES
04 ACCIDENT & INCIDENTS
INCIDENT RECORD NO. 4.001

FUNCTION NAME POSITION SIGNATURE DATE
Preparation Jurie van der Watt Group HSE Manager
Country General
Approval Lyndon Przybylski
Manager
RECORD OF AMENDMENTS
Clause(s) Effective
No Pages re-issued Revision details
amended Date
0 N/A N/A New procedure 01/04/08
New
Revision# 1 2 3 4 5 6 7 8 9
Document
Document: 08_CDSER_ OHSE_ Capital Drilling_Operational Control_09_Accidents & Incidents
Prepared By Jurie van der Watt Reviewed By Lyndon Przybylski Approved By: B. Rudd
Issue Date: 01-Jan-09 Print Date: 15-Aug-17 Review Date: 01-Jan-10
Version No: 03 Page No: Page 1 of 18
THIS DOCUMENT IS UNCONTROLLED IN HARD COPY
1. PURPOSE
To establish a database of all accidents and incidents that occurs on site and
to ensure the prompt investigation thereof.
2. SCOPE
This procedure is applicable to Capital Drilling.
3. REFERENCE DOCUMENTS
Serbia Mining Law, 18.April 2006

Serbia Occupational Safety & Health Law 2008
Accident/injury record book
Property damage record book
4. DEFINITIONS
Acceptable Risk
A risk that has been reduced to a level that can be endured by the organization,
having regard to its legal and other obligations and its own OH&S policy.
Accountable
Answerable for results, conduct and consequences.
Activity
An action taken in pursuit of RC or Diamond drilling, including support operations
Actual hazards
Existing hazards.
Adequacy
Evaluation of the performance of the OH&S management system against the

requirements of the Capital Drilling policy statement and the objectives and targets.
Annual
A period of 12 months.

Appropriate Manager
Depending on the intent of the procedure Appropriate Manager can be either a

General Manager/Managing Director or a designated Head of Department
(Determined by the relevant General Manager/Managing Director).
Audit
A systematic and, wherever possible, independent examination to determine whether

activities and related results conform to planned arrangements and whether these
arrangements are implemented effectively and are suitable to achieve the
organizations policy and objectives. Independent does not necessarily mean
external to the organization.
Audit criteria
Set of policies, procedures, requirements or arrangements used as a reference

against which audit evidence is compared.
Audit findings
Results of an audit that can indicate either conformity or non-conformity with audit
criteria or opportunities for improvement
Audit Programme
Documented schedule of one or more audits planned for a specific period and
designed to achieve a specific purpose (e.g. internal system audit, surveillance
audit).
Audit Plan
Description of the activities and arrangements for a specific audit.
Auditor
Person with the competence to conduct an audit.
Audit Scope
What and where will be audited.
Authorities
The responsibility to ensure the OH&S management system is established,

implemented and maintained and to report on the performance of the OH&S
management system

Awareness Training
Training provided to all personnel to ensure that they understand requirements of the
OH&S Management System and their individual roles and responsibilities.
Continual Improvement
Recurring process of enhancing the OH&S management system in order to achieve

improvements in overall safety, health performance consistent with the organizations
OHS&E Policy.
Contractor
A person who works for an outside company, which has been contracted by the
company to perform services for a fee.
Controlled Document
Any active or current document stored on the regional or operational document

control register.
Corrective Action
Any action taken to address and correct non-conformity.
Days Lost
This is the total number of calendar days lost due to an injury, starting with the day
following the day of the injury. Calendar days include public holidays, weekends etc.
Document
Information and its supporting medium that can be altered or amended and has a
version number.
Document Controller
Person(s) assigned to maintain the document control system. This can be

operational, regional or country. The regional document controller has final
responsibility for all Capital drilling master (generic) documents.

Duty of Care
Moral duty also referred to in law, of one person to another. All parties involved with
work have responsibilities for safety and health at work. This includes employers,
employees, self-employed persons and others, such as people who control
workplaces, design and construct buildings or manufacture and supply plant.
This duty is usually expressed in broad terms, for example: an employer must, as far
as practicable, provide a work environment in which employees are not exposed to
hazards; employees must take reasonable care for their own safety and health, and
that of others, at work; and self-employed persons must, as far as practicable,
ensure the work does not adversely affect the safety and health of others.
Effective Date
The date a document is approved.
Effectiveness
Evaluation of the effectiveness of the OH&S management system. Evaluation

criteria shall include internal and external audit findings, legal conformance audits,
non-conformity, corrective and preventive action, training needs, incident/accident
reports, emergency procedures, complaints, ongoing monitoring and measuring.
Emergency
Serious, unexpected and potentially dangerous situation requiring immediate action.
Employee
A full-time or part-time individual on the company payroll. This includes employees

on fixed-term assignments, casuals and temporary workers.
Employment
Employment means all work or activity performed in carrying out an assignment or

request of a Reporting Company or Reportable Contractor, including related
activities not specifically covered by the assignment or request.
Employment also includes activities, even outside working hours, where the
Reporting Company has the prevailing influence. Under certain circumstances travel
to and from work is also considered as being in the course of employment.
Environment
Surroundings in which an organization operates, including air, water, land, natural

resources, flora, fauna, humans, and their inter-relations.
Surroundings in this context extend from within an organization to the global system.

Equipment
The items needed for a particular purpose.
ERP
Emergency Response Plan.
Excom
Regional top management, including Capital Drilling Managing Director and

management team
External Communication
Communication from any party external to the company.
Facility
A building or service provided for a particular purpose.
FAPES
Any facilities, activities, products, equipment, services and maintenance operated by,
performed by or provided by Capital Drilling.
Fatality
A fatality is the death of an employee or contractor resulting from a work related

incident, regardless of the time intervening between the time of injury and the time of
death and:
Directly or indirectly involves an employee of the company while performing

his/her duties, or
Involves company operations, or affects company property, plant or
equipment, or
Is related as described in the above points with the activities of contractors
performing work for the Company, or
Occurs in a place that is considered to be controlled or under the significant
influence of the Company.
The death of a third party because of any of the above points must be
immediately reported but the fatality will not be included in the performance
statistics.

First Aid Case (FAC)
Work related injury, which does not normally require the attention of a medical
practitioner.
Hazard
A source or a situation with a potential for harm in terms of human injury or ill health,
damage to property, damage to the environment, harm to community relations or a
combination of these.
Hazard Identification
The process of recognizing that a hazard exists and defining its characteristics.
Hazardous Substances
Those substances which may cause injury or ill health to or death of human beings
by reason of their toxic, corrosive, irritant, strongly sensitizing, flammable or
explosive nature.
Hazardous Waste
Waste that has the potential, even in low concentrations, to have a significant
adverse effect on public health and the environment because of its inherent
toxicological, chemical and physical characteristics. Hazardous waste either is sent
to a hazardous waste landfill site or is returned for recycling. A copy of the permit or
license from the recycler, with the guarantee of how it is to be used is required where
relevant.
Hierarchy of Control
A series of hazard mitigation controls, which should be considered, and applied

where practicable, in the following order (a number of these options may be
considered and applied individually or in combination):
1. Eliminate complete elimination of the hazard

2. Substitute replacing the material or process with a less hazardous one
3. Engineering Install or using additional machinery such as local exhaust
ventilation to control the risk. Separating the hazard from operators by
methods such as enclosing or guarding dangerous items of machinery. For
example, use guards on compression testing machines.
4. Administrative providing controls such as training, procedures,
authorizations
5. Personal protective equipment (PPE) using properly fitted PPE where other
controls are not practicable

Hierarchy of Injury Classification
An injury will be reported at its worst level.
EXAMPLE 1 - an employee is injured and loses his index finger. He/she is booked
off work for 20 days. He/she returns to work but continues to receive medical
treatment (includes physiotherapy) once a week for the injury. This case will only be
recorded as a permanent partial disability and not be double reported as an MTC
for the ongoing treatment.
EXAMPLE 2 an employee cuts his/her finger and first aid treatment is given. The
first aid is ineffective and sometime later he/she has the finger amputated. What
was a first aid case then changes to a permanent partial disability. The first aid case
is then deleted from the record.
High Risk Contractor
Person or group who, by nature of their activity, product, equipment or service

generates a significant hazard to Capital Drilling or is exposed to significant risk.
High Potential Incident (HPI)
High potential incidents are unplanned, unwanted, uncontrolled events, which could
have resulted in permanent disability, death or loss of license to operate. The
purpose for recording high potential incidents is to enhance learning and avoid a
repeat with worse consequences.
HIRA
Hazard identification and risk assessment.
HIRA Team
A team of personnel, including management, OH&S and technical/non-technical

personnel, appointed to identify and evaluate the hazards and risks of Capital Drilling
operations.
HSE Coordinator
Occupational Health and Safety Coordinator for the Capital-Drilling Region.
I&AP
Refer to definition for interested and affected parties.

Ill health
A state in which you are unable to function normally and without pain
Incident
Unplanned, unwanted, uncontrolled event that caused or could have caused, injury,
damage, illness, pollution or harm to community relations including near hits.
Undesired event that caused, or could have caused, injury, damage, illness, pollution
or harm to community relations.
The term incident includes both accidents and no-loss incidents, also called near-
misses or near hits.
Independent person
Any person familiar with the technical aspects of the business of Capital Drilling and
not directly affiliated to the audit scope.
Injury
Physical harm or damage, regardless of the severity, that arises from a single event
or a number of events occurring very close together in time in the course of
employment or due to deficiencies in equipment or management controls for which
Capital Drilling and/or its operations is responsible.
Interested and/or Affected Party/Parties (I&AP)
An individual or group concerned with, or affected by, the OH&S performance of an

organization.
Internal Audit
Systematic, independent and documented process by independent auditors from
within the organisation to determine the extent to which the OH&S management
system audit criteria set by the organization are fulfilled.
Internal Communication
Communication from any personnel employed at any Capital Drilling operation.
Intranet Site
Capital Drilling intranet site, which is accessible locally at operations and/or

regionally.

Lead Auditor
Person qualified to manage and perform audits.
Lost Time Injury (LTI)
Work related injury, which results in employee not being able to perform his/her
regular duties on any day after the day on which the injury occurred. Restricted work
cases are considered to be LTIs. Regular duties are those duties that a person may
be reasonably expected to perform during the course of their current employment.
Low Risk Contractor
Person or group who, by nature of their activity, product, equipment or services does
not generate a significant hazard to Capital Drilling and is not exposed to significant
risk.
LTIFR
Lost Time Injury Frequency Rate. This is calculated by the number of lost time
injuries divided by hours worked multiplied by 1,000,000.
Management Programme / Programme
Series of specific tasks to achieve OH&S objectives and targets
Management System
Refer to definition for OH&S management system.
Mancom
Operations top management including the General Manager/Managing Director and

Heads of Department.
Measure
Ascertain the size, amount or degree of something by comparison with a standard

unit or object of a known size to assess the extent, quality, value or effect.
Medical Reports
A report provided by a medical practitioner who has examined an injured party, which
contains statements regarding fitness for work, restrictions and days on restricted
duties or off work. The report is used to verify injury classification, severity of the
injury and restrictions required.

Medical Treatment Cases (MTCs)
Work related injury which, under normal circumstances, requires treatment by or

under the specific order of a medical professional, but which does not result in lost
days or restricted work.
The treatment of minor cuts, scratches, burns etc that could normally be treated by
the injured himself, even if carried out by a physician, is classified as First Aid Cases.
Precautionary measures which may be taken, such as the taking of X-rays or other
medical examination of a person after an accident, if found to be negative (i.e. no
injury) do not count as either a medical treatment case or a first aid case. The
criteria are the treatment required not the examination.
Mini HIRA (Field HIRA)
Hazard Identification and Risk Assessment methodology developed at operational

level, which can be done swiftly, and serves to highlight and broadly assess the level
of risk and control measures required.
Monitor
Planned and regular observations and checks of any facilities, activities, products,
equipment and services.
MoU
Memorandum of Understanding describing respective OH&S responsibilities

pertaining to facilities, activities and equipment of another business unit that are
used by an Capital Drilling business unit.
MSDS
Material Safety Data Sheet. Information sheet designed to help understand how to
work safely and responsibly with chemicals in the work area. It must be ensured that
the most up-to-date MSDS is sourced.
Near hit/miss
Any occurrence that could have, but did not, result in an injury, damage, illness,
pollution or harm to community relations. The purpose for recording near hits/misses
is to enhance learning and avoid a repeat with possible worse consequences.

Nonconformity
Any deviation from work standards, practices, procedures, regulations, management

system performance, legal and other requirements, etc. that could either directly or
indirectly lead to personal injury or illness, property damage, damage to the
workplace environment, non-compliance with the management system, damage or
pollution to the ambient or wider environment (including communities) or any
combination thereof.
Non LTIFR
Non Lost Time Injury Frequency Rate. This is calculated as the total medical
treatment cases multiplied by 1,000,000 and divided by the hours worked.
Objective
Overall OH&S goal, consistent with the OHS&E policy, that an organization sets itself
to achieve.
Occupational Health and Safety (OH&S)
Conditions and factors in the workplace, which affect the well-being of employees,
temporary workers, contractor personnel and others.
Occupational Illness
Any work-related abnormal condition or disorder, other than that resulting from injury,
caused by, or mainly caused by, exposures at work. The condition arises because of
exposures over a prolonged period or because of multiple exposures to a hazardous
substance or environmental conditions.
OH&S Management System or OH&Sms
The part of the companys overall management system that includes organizational
structure, planning activities, responsibilities, practices, procedures, processes and
resources for developing, implementing, achieving, reviewing and maintaining the
OH&S policy and managing its OH&S risks..
OH&S Management System Audit
Systematic and documented verification and process of objectively obtaining and

evaluating evidence to determine whether the OH&S management system conforms
to the audit criteria set by the organization.

OHS&E Policy
Overall intentions and direction of the organization related to its occupational health
and safety performance as formally expressed by top management. The
Occupational Health, Safety & Environmental Policy Statement is issued by Mancom
(at operational level) & Excom (at regional level) and reviewed periodically.
Operation
Any area where Capital Drilling is conducting work.
Organization
A company, operation, firm, enterprise, institution, or association, or part thereof,

whether incorporated or not, public or private, that has its own functions and
administration. For organizations with more than one operating unit, a single
operating unit may be defined as an organization.
Other Requirements
Those documents adopted by Capital Drilling regionally and/or operationally e.g.

documents, conventions, treaties, other documents that Capital Drilling is a signatory
to, conventions and treaties that the host country is signatory to, license/permit
requirements, national standards of host countries.
Outsourced Processes
Activities, services and processes carried out by service providers that we influence
or can influence.
Performance
The measurable results of the OH&S management system, related to the

organizations control of health and safety related risks, based on its OHS&E policy
and objectives.
Performance Standard
Agreed standard(s) by which performance is measured.
Permanent Partial Disability
A permanent partial disability is a work injury, which results in the complete loss, or
permanent loss of use, of any member or part of the body or any impairment of
functions of parts of the body, regardless of any pre-existing disability of the injured
member or impaired body function.

Permanent Total Disability
A permanent total disability is any work injury, which permanently incapacitates an
employee and results in termination of employment.
Personnel
Any person, including contractors, having access to any Capital Drilling facility that is
performing a service for Capital Drilling on a regional or operational level.
Planned Arrangements
Plans or measures taken to achieve defined goals and which are developed in an
organized manner.
Potential Hazards
Hazards that could arise as changes occur.
Preventive Action
The action(s) required to avoid the occurrence of nonconformity.
Procedure
Specified way to carry out an activity or a process. Procedures should be

documented e.g. formal document, video, sign, list of instructions.
Products
Any substance used or generated by Capital Drilling regionally or locally.
QA/QC
Quality Assurance/Quality Control.
Record
A document of historical importance stating results achieved or providing evidence of

activities performed.
Regional OH&S Management Committee
Regional Executive Officer, Regional OH&S Coordinator and those persons Regional
Executive Officer appoints from time to time within the region.
Regular/Regularity
Recurring uniformly time e.g. fire drills will be carried out at least once a year.

Responsibilities
The tasks a person must complete to effectively implement and maintain the OH&S
management system.
Restricted Work Case (RWC)
Injuries resulting in restricted work activity (light duty) where a person can work, but
cannot perform their regular duties. Restricted work cases are recorded as lost time
injuries.
Restricted Work Days
This is the total number of calendar days that any injured employee is unable to
carry out their regular duties, although they are allowed to return to work. These
days will be counted as days lost due to lost time injuries (LTIs).
Risk
Combination of the likelihood and potential consequences of a specified hazardous

event occurring.
Risk Assessment
The overall process of estimating the magnitude of risk and deciding whether the risk
is tolerable.
Role
The part a person plays to effectively implement and maintain the OH&S
management system.
RRA
Roles, Responsibilities and Authorities.
Safety
Freedom from unacceptable risk of harm (ISO/IEC Guide 2).
Senior Management
At each relevant level of the organisation from operational to regional the most
senior members responsible for making decisions and accountable for outcomes in
their areas of responsibility.
Services
Any service used or rendered by Capital Drilling including its operations.

Significant Risk
Risks which are rated 28+ in the current Capital Drilling HIRA matrix are considered
to be significant and are prioritized for controls to be implemented.
SOP
Standard Operating Procedure.
Stakeholder
Any person or group who is in any way affected by the activities of Capital Drilling
including its operations.
Standard
The OHSAS 18001:2007 standard
System
Set of interrelated or interacting elements.
Target
Detailed performance requirement, quantified where practicable, applicable to the

organization or parts thereof, that arise from the OH&S objectives and that need to
be set and met in order to achieve those objectives.
TRIFR
Total Recordable Injury Frequency Rate. This is the sum of the MTCs and LTIs
divided by the hours worked multiplied by 1,000,000
Uncontrolled Document
Any copy of a controlled document.
Workplace
Any area where work is conducting.

5.0 ACRONYMS
Acronym
CD Capital Drilling
ERP Emergency Response Plan
FAC First Aid Case
FAPES Facilities, Activities, Products, Equipment, Services and Maintenance
HCS Hazardous Chemical Substance
HIRA Hazard Identification and Risk Assessment
HPI High Potential Incident
I&AP Interested and Affected Parties
ISO International Organization for Standardization
LTI Lost Time Injury
LTIFR Lost Time Injury Frequency Rate
LTISR Lost Time Injury Severity Rate
M&M Monitoring and Measuring
MoU Memorandum of Understanding
MP Management Programme
MSDS Material Safety Data Sheet
MTC Medical Treatment Case
NCR-CAR Non-conformance Report - Corrective Action Record
O&T Objectives and Targets
OH&S Occupational Health and Safety
OHSAS Occupational Health and Safety Assessment Specification
PPE Personal Protective Equipment
QA/QC Quality Assurance/Quality Control
RRA Roles, Responsibilities and Authorities
RWC Restricted Work Case
SOPs Standard Operating Procedures
TRIFR Total Recordable Injury Frequency Rate
WI Work Instruction
6. PROCEDURE
All injuries irrespective of the severity shall be reported to line management
immediately.
The HSE Department shall be notified by the quickest means possible.
The HSE Department is responsible to ensure that the appropriate legal
documentation is completed.
All incidents and damages must be recorded in the given incident-reporting
book.
All injuries must be recorded in the given injury-reporting book.
All records of incidents, damages, personal non-compliances and injuries
shall be kept at the HSE Department.
7. RESPONSIBILITY
HOD, area responsible person, safety representative and Safety Officer will
conduct monthly inspections on compliance to this element.
Deviations must be reported to the area responsible person who must rectify
as soon as possible.
8. RECORDS
The HOD must fill in monthly walk about inspection report.

The part time safety rep must use their logbook.
The Safety Officer must use his deviation sheet to fill in all deviations found.
9. DISCIPLINARY ACTION
Disciplinary action will be taken against an employee found to be in breach of

this Standard.


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SAFE OPERATING PROCEDURES

04 ACCIDENT & INCIDENTS

INCIDENT RECORD NO. 4.001

Preparation Jurie van der Watt Group HSE Manager

This procedure is applicable to Capital Drilling.

Serbia Mining Law, 18.April 2006

Answerable for results, conduct and consequences.

An action taken in pursuit of RC or Diamond drilling, including support operations

Evaluation of the performance of the OH&S management system against the

Document: 08_CDSER_ OHSE_ Capital Drilling_Operational Control_09_Accidents & Incidents

Depending on the intent of the procedure Appropriate Manager can be either a

A systematic and, wherever possible, independent examination to determine whether

Set of policies, procedures, requirements or arrangements used as a reference

Description of the activities and arrangements for a specific audit.

Person with the competence to conduct an audit.

What and where will be audited.

The responsibility to ensure the OH&S management system is established,

Document: 08_CDSER_ OHSE_ Capital Drilling_Operational Control_09_Accidents & Incidents

Recurring process of enhancing the OH&S management system in order to achieve

Any active or current document stored on the regional or operational document

Any action taken to address and correct non-conformity.

Person(s) assigned to maintain the document control system. This can be

Document: 08_CDSER_ OHSE_ Capital Drilling_Operational Control_09_Accidents & Incidents

The date a document is approved.

Evaluation of the effectiveness of the OH&S management system. Evaluation

Serious, unexpected and potentially dangerous situation requiring immediate action.

A full-time or part-time individual on the company payroll. This includes employees

Employment means all work or activity performed in carrying out an assignment or

Surroundings in which an organization operates, including air, water, land, natural

Document: 08_CDSER_ OHSE_ Capital Drilling_Operational Control_09_Accidents & Incidents

The items needed for a particular purpose.

Emergency Response Plan.

Regional top management, including Capital Drilling Managing Director and

Communication from any party external to the company.

A building or service provided for a particular purpose.

A fatality is the death of an employee or contractor resulting from a work related

Directly or indirectly involves an employee of the company while performing

Document: 08_CDSER_ OHSE_ Capital Drilling_Operational Control_09_Accidents & Incidents

A series of hazard mitigation controls, which should be considered, and applied

1. Eliminate complete elimination of the hazard

Document: 08_CDSER_ OHSE_ Capital Drilling_Operational Control_09_Accidents & Incidents

An injury will be reported at its worst level.

High Risk Contractor

Person or group who, by nature of their activity, product, equipment or service

High Potential Incident (HPI)

Hazard identification and risk assessment.

A team of personnel, including management, OH&S and technical/non-technical

Occupational Health and Safety Coordinator for the Capital-Drilling Region.

Refer to definition for interested and affected parties.

Document: 08_CDSER_ OHSE_ Capital Drilling_Operational Control_09_Accidents & Incidents

Interested and/or Affected Party/Parties (I&AP)

An individual or group concerned with, or affected by, the OH&S performance of an

Communication from any personnel employed at any Capital Drilling operation.

Capital Drilling intranet site, which is accessible locally at operations and/or

Document: 08_CDSER_ OHSE_ Capital Drilling_Operational Control_09_Accidents & Incidents

Person qualified to manage and perform audits.

Lost Time Injury (LTI)

Low Risk Contractor

Management Programme / Programme

Series of specific tasks to achieve OH&S objectives and targets

Refer to definition for OH&S management system.

Operations top management including the General Manager/Managing Director and

Ascertain the size, amount or degree of something by comparison with a standard