1. KFAA Project Abnormal Event Report Form
Ref: 20221226-143-BSS-SAJ-PD-021-035 Rev: 26, December 2022 Page 1 of 3
Part 1 – Notification and Initial details, should be completed and submitted by the responsible organization’s H&S Team within 24 hours of
the Event
Part 1 – Notification and Initial Details
Report Reference No. 20221226-143-BSS-SAJ-PD-021-035
Contractor BSS JV Contract No. SAJCO (Sub-Contractor) nr:
84000 dated 24/06/2020
Programme / Project KFAA Location. Building FW02-2
IP 01
First Name N/A Trade N/A
Last Name N/A Age N/A
Company N/A Nationality N/A
Initial Details of the Event
Current Classification of Event (see Definitions Section of Form for details). Tick all which apply
Days Away from Work Restricted Workday Fatality First Aid Medical Treatment
Motor Vehicle Accident Near Miss (NM) Property Damage Recordable
Actual Severity 1 2 3 4 5 Worst Potential Severity 1 2 3 4 5
Date: 26/12/2022 Time: 17:20hrs Day of Week: Monday
Brief Description of the Event:
On Monday 26th December 2022 around 17:20hrs, SAJCO roller compactor bearing Equipment # 4-357 was
compacting soil bed for land scape work around building FW02-2. The compactor was compacting near the stairs
of building FW02-2. While reversing, the compactor hit to the handrails installed at the stairs of building FW02-2
resulting to which damage reported to handrail and stairs.
No Injury to any person reported because of the incident.
Body part affected (include left or right front or back as applicable):
NA
Status of the injured person:
NA
Was first aid treatment required? Yes No
Was medical treatment required (if yes provide details such as treatment provided and how long in hospital)? Yes No
Was a road vehicle involved (if yes provide details including registration number, make and model Yes No
What immediate actions were taken to make safe and/or prevent recurrence:
1- Stopped the Work immediately.
2- Advised supervisor to provide banks man with equipment.
3- Construction team was advised to use manual compacting in congested areas to avoid recurrence.
2. KFAA Project Abnormal Event Report Form
Ref: 20221226-143-BSS-SAJ-PD-021-035 Rev: 26, December 2022 Page 2 of 3
Incident Pictures:
3. KFAA Project Abnormal Event Report Form
Ref: 20221226-143-BSS-SAJ-PD-021-035 Rev: 26, December 2022 Page 3 of 3
