Organization

Public Health & Safety Department :‫الوحدة التنظيمية‬

Unit:
Form sheet Technical Guideline for Accident
: ‫اسم النموذج‬
title: Investigation and Reporintg
Doc Ref. DM-PH&SD-P7-A-TG xx : ‫رقم النموذج‬

TECHNICAL GUIDELINE FOR ACCIDENT INVESTIGATION AND

REPORTING

I. INTRODUCTION

This document establishes the procedure and guidelines for the proper understanding and
implementation of accident investigation and reporting within the Emirate of Dubai.

II. OBJECTIVES

The primary objectives of this Technical Guideline are the following:

 Establish the common definition of the terms used in accident related cases - from
investigation to reporting;
 Establish a uniform reporting format for workers exposure, accident reporting and
investigation in the Emirate of Dubai to be used by all premises
 Ensure that all work related accidents and injuries shall be investigated and reported.
 Ensure compliance of reporting for any occupational and work related injuries,
accidents and ill- health within the Emirate of Dubai

III. SCOPE

This Technical Guideline shall be applicable for all types of Occupational and Work Related
Accidents and Illnesses in the workplaces in the Emirate of Dubai – including but not limited
to government and private offices, construction and project sites, hotels and recreation
facilities, commercial establishments.

IV. DEFINITION OF TERMS

Accident An event that cause harm,illness or injury or damage to the

property or fatality.

Near Miss An event that could/had the potential to cause harm,illness or

injury or damage to the property or fatality.

Occupational Illness A condition that results from exposure in a workplace to a physical,

chemical or biological agent to the extent that the normal
physiological mechanisms are affected and the health of the worker
is impaired thereby and includes an industrial disease. (Art. 37-9,

Occupational Health and Safety Section Page 1

 Organization
Public Health & Safety Department :‫الوحدة التنظيمية‬
Unit:
Form sheet Technical Guideline for Accident
: ‫اسم النموذج‬
title: Investigation and Reporintg
Doc Ref. DM-PH&SD-P7-A-TG xx : ‫رقم النموذج‬

Local Order 61-91)

Victim/s Party/ies directly involved in an incident
Party/ies at the receiving end of the accident
Witness/es Party/ies who saw the actual event that led to an incident and/or
accident
Corrective Action Action to eliminate the cause of a detected incident and/or accident
Preventive Action Action to eliminate the cause of a potential incident and/or accident
Time Lost The code of practice defines loss of working time as "lost days
counted from and including the day following the day of the
accident, measured in calendar days, weekdays, work shifts or
working days". Calendar days are preferable as a measure of
accident severity, while working days are preferable as a measure of
economic impact.

V. ROLES AND RESPONSIBILITIES

Factory /Department  Reviews corrective and preventive action plans and its
Committee effectiveness
Investigation Team  Investigates the incident or accident and identify all possible
causes using the Basic Causes and Symptoms Guide.
 Recommends corrective and preventive action plans
Safety Officer/Safety  Helps coordinate investigation of incidents and accidents
Representitive.  Records incidents and accidents
 Validates the Incident/Accident Report whenever necessary
 Communicates incidents, accidents and decisions on
corrective and preventive actions
 Evaluates the effectiveness of corrective and preventive
actions
 Reports the accident record summary to Department of
Public Health and Safety (Occupational Health and Safety
Section) using the attached forms

Line Managers/  Form and lead an Investigation Team

Section Heads/ Direct  Prepare the preliminary incident/accident report and submit
Superiors it to the Safety Officer or Safety Contact Person.
 Implement initial corrective action to contain the extent or
damage, injuries or non-conformities
Victim/s and/or  Report incidents or accidents to immediate supervisor
Witness/es

Occupational Health and Safety Section Page 2

 Organization
Public Health & Safety Department :‫الوحدة التنظيمية‬
Unit:
Form sheet Technical Guideline for Accident
: ‫اسم النموذج‬
title: Investigation and Reporintg
Doc Ref. DM-PH&SD-P7-A-TG xx : ‫رقم النموذج‬

VI. INVESTIGATION AND REPORTING PROCEDURE

1.0 Witness/es or the victim (if he is able) to immediately report the incident or accident
to Immediate Supervisor.
2.0 Immediate Supervisor to mitigate the hazard or hazardous event that led to the
incident or accident.
3.0 Immediate Supervisor to investigate the incident or accident
3.1 Form and lead an Investigation Team, composed of the victim, if available,
witness, and Safety Officer or Coordinator
3.2 Invite other party/ies, whenever necessary, to help identify possible causes of
the incident or accident
3.3 Identify all possible causes using the Basic Causes & Symptoms Guide
3.4 If the victim is not available, proceed with the investigation and validate the
result of the investigation with the victim at the appropriate time
3.5 Recommend corrective and preventive action plans
4.0 Prepare the report using the Incident/Accident Report Form in Annex 1 ,and submit it
through the E-service of the Dubai Municipality.
5.0 Secure concurrence of the report from the members of the Investigation Team
6.0 Sign the Incident/Accident Report
7.0 Submit Incident/Accident Report to the management within:
7.1 24 hours after a fatal or lost time accident.
7.2 48 hours after a first aid or near miss-miss accident.
7.3 Two copies to be retained by the factory, department section concerned
7.4 One copy to be provided to the Site Safety Officer
7.5 For FATALITY or multiple injury cases, a copy shall be submitted within 24
hours to Dubai Municipality – Occupational Health and Safety Section.
**Failure to submit, the company may be subjected to strict prosecution..
8.0 Validate the Incident/Accident Report whenever necessary
8.1 Advise the Factory Manager or the Department Head
8.2 Convene the Safety Committee
8.3 Call the victim to narrate the event/s that led to the incident or accident
8.4 Validate the victim’s learning
8.5 Validate the corrective and preventive action plan/s
8.6 Advise the Investigation Team on the most appropriate action plans to take
9.0 Update Incident/Accident Report and close when all action plans are completed and
complied

Occupational Health and Safety Section Page 3

 Organization
Public Health & Safety Department :‫الوحدة التنظيمية‬
Unit:
Form sheet Technical Guideline for Accident
: ‫اسم النموذج‬
title: Investigation and Reporintg
Doc Ref. DM-PH&SD-P7-A-TG xx : ‫رقم النموذج‬

10.0 Update the relevant government agency (DM – Department of Public Health and
Safety – Occupational Health and Safety Section) using the prescribed report format.

VII. HANDLING OF LOST TIME ACCIDENTS

 Only the Company Physician (or retained medical consultants) or his representative
can decide when an injury requires the employee to take a leave.
 The Company Physician should coordinate with the immediate Supervisor before
granting a leave.
 If an accident leave is necessary (unless hospitalized) the Company Physician shall
initially grant a one day leave and require the employee to report to the clinic the
following day for further examination.
 Should further leave be required, the Company Physician should coordinate with the
Department Head of the employee on his granting the number of days as factory
accident leave.
 The employee is only allowed to return to work when a “Fit to Work notice” is
issued by the Company Physician.

VIII. BASIC CAUSES AND SYMPTOMS GUIDE

Lack of Knowledge Employee Placement Issue

 Employee not qualified to perform task  Physical overexertion
 Safe method not known or understood  Task exceeded medical restrictions
 Improper use of equipment  Recurrence of a previous illness
 Inadequate equipment for the task  Not physically fit or able to continuously
 Employee not properly trained to perform the task
perform the task
Unsafe Method Not Enforcing Safe Practices
 No established procedure  Inconsistent enforcement of safe
 Existing procedure did not recognize the practices
hazard  Similar unsafe/wrong behavior not
confronted
 Written practices and/or procedures not
followed (using short cuts)

Inappropriate Design/Substandard Construction Inadequate Personal Protective Equipment

 Unsafe or wrong design/construction  Necessary safety equipment not available
 Inadequate guarding  Inadequate protection for task performed
 Difficult to perform the task safely  Inadequate eye protection
 Exposed pinch point or other hazards  Inadequate respiratory protection
 others
Inadequate Inspection and Maintenance Inadequate Feedback System
Program  Safe behavior is "punishing" while unsafe
 Defective tools and equipment behavior is "rewarding"
Occupational Health and Safety Section Page 4
 Organization
Public Health & Safety Department :‫الوحدة التنظيمية‬
Unit:
Form sheet Technical Guideline for Accident
: ‫اسم النموذج‬
title: Investigation and Reporintg
Doc Ref. DM-PH&SD-P7-A-TG xx : ‫رقم النموذج‬

 Inoperative safety device  Task completion is emphasized over safe

 Inadequate/wrong chemical labelling completion
 Hazard created by normal wear and tear  Inadequate feedback given on similar
 Equipment / device used needed repair unacceptable behavior
 Equipment / device failed during use  Production or other factors implied over
safe performance
Inadequate / Inferior Equipment Others
 Required safety features and interlocks  Performance Error (similar accident)
not provided  Absent-mindedness
 Frequent maintenance required  Gross Negligence
 Complicated and not user-friendly  Deliberate Action, etc.
operation

XI. ATTACHMENTS

 Attachment 1 - Incident/Accident Report Form

 Attachment 2 – Employers' Accident / Illness Report

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 Organization
Public Health & Safety Department :‫الوحدة التنظيمية‬
Unit:
Form sheet Technical Guideline for Accident
: ‫اسم النموذج‬
title: Investigation and Reporintg
Doc Ref. DM-PH&SD-P7-A-TG xx : ‫رقم النموذج‬

Attachment No. 1

INCIDENT / INJURY REPORT FORM

PART 1 GENERAL INFORMATION

Name of Establishment (Dept./Section):

Type/Nature of Business:
Location: License No.
Email Add. Tel. No./Fax No.
Contact Person: Mobile No.
Designation: Number of Employees:
PART 2 INCIDENT INFORMATION
Date/time of the Incident: ______________________ Place of the Incident: ________________________________
Where did the incident happened: Please describe the specific location of where the incident happened and
 within the workplace whether he is working alone or with other workers.
 in the field work
 during official business
 during official travel
PART 3 INJURED EMPLOYEE DATA
Name of Injured Person: Employee. No. Age: Sex: Date of Birth:

Position: Nationality: Length of Service: Duty/Time:

PART 4 DETAILS OF THE INJURY

What was the injury?
What part of the body was injured?
Was the injury (tick one box that applies) Is there damaged to the machinery or equipment?
Single Multiple______ (how many)  Damaged Machinery/Equipment: _____________________
 a fatality? ___________________________________________________
 a major injury or condition?
 an injury which require more than 3 days off from work  Vehicle (Company-owned / Personal): ____________________
 an injury which require out-patient hospital treatment Please give additional details such as Plate No. and/or if there
(or less than 24 hours) are other vehicles involved in the accident.
 a first aid case ___________________________________________________
 a near-miss accident ___________________________________________________

PART 5 DETAILS OF THE ACCIDENT (Please tick the box that best describes what happened and go to part 6)
 Contact with moving machinery or material being  Exposed to or in contact with chemical or harmful
machined substances
 Hit by a moving, flying or falling object  Exposed to fire
 Hit by a moving vehicle  Exposed to an explosion
 Hit something fixed or stationary  Contact with electricity or an electrical discharge
 Injured while handling, lifting or carrying  Injured by an animal
 Slipped, tripped or fell on the same level  Physically assaulted by a person
 Fall from a height ___________ meters  Road and/or traffic related accident
 Trapped by something collapsing  Other kind of accident (describe it in part 6)
 Drowned or asphyxiated

PART 6 DESCRIPTION OF THE ACCIDENT - Please give as much details as you can such as: the event that led to

Occupational Health and Safety Section Page 6

 Organization
Public Health & Safety Department :‫الوحدة التنظيمية‬
Unit:
Form sheet Technical Guideline for Accident
: ‫اسم النموذج‬
title: Investigation and Reporintg
Doc Ref. DM-PH&SD-P7-A-TG xx : ‫رقم النموذج‬

the accident, the name & type of machineries or equipment involved, name of the substance involved, contributing factor
made by people that led to the accident, etc. Use separate paper and add sketch, photographs or other details if necessary.

Name/Signature of Supervisor: Name/Signature of Witness/es:

PART 7 ROOT CAUSE/S IDENTIFICATION (What are the main reasons leading to the incident?)

PART 8 CORRECTIVE & PREVENTIVE MEASURES (What are the corrective actions and preventive measures to
prevent similar incident )
Root Cause/s Action Plan/s Who When

Name & Signature of Immediate Superior: Date:

Name & Signature of Safety Officer: Date:

Note: Please submit a filled-out copy of this form to Occupational Health & Safety Section (Department of Public Health &
Safety) through the E-service and if you need any help please call 800900 or contact the following numbers: 04-606-6063 or to
046066890 for all accidents/incidents which require the presence and investigation of Dubai Municipality, Dubai Police, Dubai
Civil Defense and/or other relevant Government Office.

Occupational Health and Safety Section Page 7

 Organization
Public Health & Safety Department :‫الوحدة التنظيمية‬
Unit:
Form sheet Technical Guideline for Accident
: ‫اسم النموذج‬
title: Investigation and Reporintg
Doc Ref. DM-PH&SD-P7-A-TG xx : ‫رقم النموذج‬

Attachment No. 2

WORK ACCIDENT & ILLNESS EXPOSURE DATA REPORT

1. Name of Establishment:
2. Type/Nature of Business:
3. Location: 4. License No.
5. Email Add. 6. Tel. No. 7. Fax No.
8. Contact Person: 9. Designation:
10. Mobile No. 11. Number of Employees:
EXPOSURE DATA January to December __________________
Total Hours Worked (by all Employees during the year)
Number of Employees: _______________________
______________________________________________
1st 2nd 3rd 4th Year to
INJURY SUMMARY
Quarter Quarter Quarter Quarter Date
Total Reported Incidents
Total Reported Fatalities
Total Reported and recorded Disabling Injuries
Total Reported Lost Time Injuries
Total Reported Near Misses
Total Reported and recorded Illnesses
Frequency of Accidents
Severity of Accidents

Note: General Manager and Safety Officer

1. This report shall be accomplished whether or not there were accident/illness occurrences during the period
covered and to be submitted to Dubai Municipality - Occupational Health and Safety Section (Department of Public
Health and Safety) Fax No. 04-703-3595 not later than 30th day of the month following the end of each calendar
year.

2. Frequency Rate is the total number of disabling injuries per million-employee hours of exposure.
Frequency Rate = Total number of disabling injuries x 1,000,000 Employee-hours of Exposure

3. Severity Rate is the total number of days lost or charged per million-employee hours of exposure.
Severity Rate = Total number of days lost or charged x 1,000,000 Employee-hours of Exposure

4. Exposure is the total number of hours worked by all employees in each establishment including employees of
operating production, maintenance, transportation, electrical, administrative, sales and other departments.

5. Disabling injuries - work injuries, which result in death, permanent total disability, permanent partial disability or
temporary total disability.

6. Non-disabling injuries (Medical Treatment) - injuries which do not result into disabling injuries but required first
aid or medical attention of any kind.

Occupational Health and Safety Section Page 8

 Organization
Public Health & Safety Department :‫الوحدة التنظيمية‬
Unit:
Form sheet Technical Guideline for Accident
: ‫اسم النموذج‬
title: Investigation and Reporintg
Doc Ref. DM-PH&SD-P7-A-TG xx : ‫رقم النموذج‬

***********************************************************************************************************

Further information is available from:

Occupational Health and Safety Section

Public Health and Safety Department
Dubai Municipality
Tel: 090000640/090000000 Fax: 2270160

Occupational Health and Safety Section Page 9