PT.

EKA PAKSI SEJATI

DOCUMENT TITLE: DOCUMENT NO. : REV.
EPS-I-009 0
ACCIDENT AND INCIDENT REPORTING SYSTEM
PROCEDURE EFECTIVE DATE:
January 2016

PREPARED BY REVIEWED BY APPROVED BY

HES Coordinator Site Manager Project Manager

PROJECT :

COMPANY :

CONTRACTOR :

LOCATION :

REVISION RECORDS
REV. DATE DESCRIPTION PREPAIR REVIEWED APPROVED
BY BY BY
0

DISTRIBUTION REMARKS
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TABLE OF CONTENTS
Page
1 INTRODUCTION …………………………………………………………………………….. 2
2 SCOPE ………………………………………………………………………………………... 2
3 REFERENCE ………………………………………………………………………………… 2
4 DEFINITION ………………………………………………………………………………….. 2
5 RESPONSIBILITIES ………………………………………………………………………… 6
6 PROCEDURES ………………………………………………………………………………. 6
6.1 Measurement of Recordable Injury and Illness Experience ………………….. 6
6.2 Accident Preparedness …………………………………………………………… 7
6.3 Actions to be taken immediately after an accident …………………………….. 8
6.4 Urgent Notice ……………………………………………………………………… 8
6.5 Investigation Process ……………………………………………………………… 9
6.6 Analysis of Accident Cause ……………………………………………………… 12
6.7 Recommendations ………………………………………………………………… 13
6.8 Reporting …………………………………………………………………………… 14
6.9 Records …………………………………………………………………………….. 15
6.10 Distribution of Report ……………………………………………………………… 15
7 VERIFYING DOCUMENTS ………………………………………………………………… 15
8 APPENDICES ………………………………………………………………………………... 16
Appendix-1a Tabulation of Scheduled Charges for Disability Cases based on
OSHA and ANSI
Appendix-1b Chart of Scheduled Charge for Hand and Foot based on OSHA and
ANSI
Appendix-2 Flow Chart for Record ability of Cases
Appendix-3 Accident/Incident Report Flowchart For Project
Attachment Form Report
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1.0 INTRODUCTION

The purposes of Accident & Incident Reporting are:

 To identify the immediate and basic causes of accidents,
 To establish effective measures to prevent the recurrence of similar accidents.
 To reporting, evaluation and statistic of HES performance.

2.0 SCOPE

This procedure gives the detailed requirements to be followed in investigating

accidents/incidents and preparing reports occurred at all construction sites, maintenance work
and all activities of CONTRACTOR.

3.0 REFERENCE

CONTRACTOR Project HES Plan Doc .No. EPS-I-001

4.0 DEFINITIONS

4.1 Accident

An undesired event that results in harm to people, damage to property or loss of work;
 Fatalities.
 Permanent (Total/Partially) Disabling Injuries.
 Occupational Illnesses.
 Environmental Accident

4.2 Near-Miss

An occurrence that involves equipment damage, property damage, loss of product, or loss of
production time:
 Traffic Accidents.
 Fires and Explosions.
 Property Damage exceeding a specified value
 Other Near Miss
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4.3 Medical treatment

Includes treatment of injuries administered physicians, registered professional personnel or lay

person. Medical treatment does not include first aid treatment even though administered by
registered professional personnel.

4.4 First Aid

Any one-time treatment and subsequent observation of minor scratches, cuts, burns, splinters,
and so forth, which do not require ordinarily medical care even thought provided by a
physician or registered professional personnel.

4.5 Work Related Case

Any occupational injury suffered by an employee, which results from a work accident or from
an exposure involving a single incident in the work environment, and any illness caused by
exposure to environmental factors associated with employment.

Occupational Injury: Any injury such as a cut, fracture, amputation, etc., that results from a
work accident or from an exposure involving a single incident in the work environment.

Occupational Illness: Any abnormal condition or disorder of an employee, other than one
resulting from an occupational injury, caused by exposure to environmental factors associated
with employment.

4.6 Recordable Case

Any work-related injury case requiring more than first aid, and all occupational illnesses.
Recordable cases include:
a) Deaths, regardless of the time between occupational injury or illness and death
b) All occupational illnesses
c) All occupational injuries resulting in any of the following:
 Lost workdays: either days away from work or days of restricted work activity
 Medical treatment other than first aid
 Restriction of work or motion
 Temporary or permanent transfer
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4.7 Environmental Accident

An accident including pollution of the environment which has/could have influence on the
environment and / or hazardous waste spill to the air, water, ground, that exceed thresholds
limit that stipulated.

4.8 Total Exposure Hours (Project Hours)

The total number of hours worked by all employees, including those in construction,
maintenance, transportation, clerical, administrative, and other activities, at the construction
site and at other work locations, which are under control by CONTRACTOR. However, leave,
sickness and other absences and private activities are excluded.

Exposure Hours are to be actually hours worked taken from payroll or time clock records
including only actual straight-time hours and actual overtime hours worked.

When actual hours are not available, estimated hours may be used. Estimated hours should
be obtained by multiplying the total employee-days worked for the period by the average
number of hours worked per day.

4.9 Lost Work Days

4.9.1 Lost Workdays: Days Away From Work

Days away from work are those workdays (consecutive or not) on which the employee
would have worked but could not because of occupational injury or illness.

The number of Lost Workdays should not include the day of injury or onset of illness
or any days on which the employee would not have worked even though able to work.

Sunday or national holidays, if not scheduled to work, should not be counted as Lost
Workdays.

Days Lost shall be calculated by:

"Number of days absent from work X 300/365" (Drop decimal fractions)

4.9.2 Lost Workdays: Days of Restricted Work Activity

Days of restricted work activity are those workdays (consecutive or not) on which,
because of the occupational injury or illness, the employee was assigned to another
job on a temporary basis, worked at a permanent job less than full time, or worked at
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a permanently assigned job but could not perform all duties normally connected with
it.

The number of Restricted workdays should not include the day of injury or onset of
illness or any days on which the employee would not have worked even though able
to work.

4.9.3 Lost Workdays of Death and Permanent, Total / Partial Disability Case

a) Each Death resulting from occupationa1 injury or illness is assigned a time charge
of 6.000 days.
b) Permanent Total Disability: 6.000 days
c) Permanent Partial Disability is a permanent loss or loss of use of a part of body
from an occupational injury or illness.
d) A time Charge for permanent total or partial disability cases is measured in
accordance with schedules given in Appendix-1a & 1b “Scheduled Charge of
Disability Cases” regardless of days absent from work.

4.10 Lost Workday Case

Any recordable case that results in lost workdays away from work or workdays of restricted
activity.
4.10.1 Lost Workdays Case with Days Away from Work:

Any recordable case that results in one or more days away from work as defined in
subsection 4.9.1.

4.10.2 Lost Workday Case with Days of Restricted Work Activity:

Any recordable case that results in one or more days of restricted work activity as
defined in subsection 4.9.2

4.11 Lost Time Injury (LTI)

A case fatality (permanent total disability) or lost workdays cases (partial disability cases).
Total LTI are number a case fatality and lost workdays (day away from work) exclude
restricted workday case.
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5.0 RESPONSIBILITIES

Project Manager (PM) is responsible to leadership and commitment to keep the HES
Performance and ensure company policy conducted properly, in compliance with laws and
rules and reporting of achievement the HES Performance to CONTRACTOR Top
Management.

The Site Manager (SM) has prime responsibility to ensure that company policy at the site
project meet the laws and rules, and compliance with this procedure.

Site HES Coordinator is responsibility to assist SM to all HES Management aspect in

establishments, developing and evaluation in this procedure to the achievements of the HES
Performance.

All Management Line must support in promoting, reviewing the HES Performance, and its
effectiveness for compliance this procedure.

All employees either direct or indirect that involved in working shall assist Accident
Investigation Team to collect of fact finding to identify root caused and prevent reoccurrence of
accident/incident.

6.0 PROCEDURE

6.1 Measurement of Recordable Injury and Illness Experience

6.1.1 Lost Time Injury/Illness Rate: LTIR / (FR)

(Incidence Rate of Deaths plus Lost Workday Cases)
This Incidence Rate is based upon the total number of recordable cases, which
resulted in death plus the number of lost workday cases with days away from work,
as defined in subsection 4.10.1 that occurred during the period covered by the rate.
The following formula should be used:

LTIR = No. of Lost Workday Cases X 1,000,000

Total Exposure Hours

Note : Number of Restricted Workdays Case is not included

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6.1.2 Recordable Injury/Illness Rate: RIR / (IR)

This incidence rate is based upon the total number of recordable cases, as defined
in subsection 4.6, that occurred during the period covered by the rate.
The following formula should be used:

RIR = No. of Recordable Cases X l,000,000

Total Exposure Hours

Note: Number of Restricted Workdays Cases is included

6.1.3 Lost Time Injury/Illness Severity Rate: LISR / (SR)

This incidence rate is based upon the total number of workdays lost, as defined in
subsection 4.9.1 that occurred during the period covered by the rate.
The following Formula should be used:

LISR = No. of Lost Workdays X l,000,000

Total Exposure Hours

Note: Number of Lost Workdays of Restricted Work Cases is not included

6.2 Accident Preparedness

The Site Manager and Site HES Coordinator shall establish an Emergency Communication
Network, which includes the Project Manager and HES Management Office of
CONTRACTOR, the Client's relevant personnel, First-aid Station, designated Hospitals, and
the local Police and Fire Stations, etc.

Their locations and telephone numbers shall be posted at the prominent locations in the
offices.

When an accident occurs, all urgent activities and necessary communication shall be taken
through the Network.

All managers and employees shall be informed of the Emergency Communication Network at
the Safety Induction Course for New Entrants.
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6.3 Actions to be taken immediately after an accident

In case of an injury, first aid shall be given to the injured person, and the First-Aid Station or
the Clinic's doctor or nurse shall be called. When the injury is serious, transport the injured by
an ambulance or other vehicle to the hospital designated.

When a fire breaks out, workers near the fire shall stop work and try to put out fire with fire
extinguishers, etc., before a fire brigade arrives.

In the case of an explosion, as there is possibility of other explosions, all workers in the vicinity
shall stop work, turn off their equipment, evacuate to the designated location, and wait for
further instruction.

The finder of these accidents shall immediately inform the CONTRACTOR Site Office and the
Client’s relevant office of the facts through the Emergency Communication Network.
The first information shall be brief and to point on the nature and seriousness of the accident,
an estimate of severity, and necessity for assistance from a hospital, fire station, etc.

According to the first information, the General Site Manager and Site HES Coordinator or
other responsible person shall ask the Client, Hospital, and/or Fire Station for assistance. See
appendix-08.

6.4 Urgent Notice

When an accident involves fatality, lost-time injuries or illness, or serious damage to property
such as process, facilities, or equipment due to fire, explosion or other disasters such as
earthquakes, typhoons, etc., the Site Manager shall immediately inform to the Project Manager,
the HES Management Office of CONTRACTOR, the Client's relevant offices, and if required the
Police or designated Local Authorities by telephone of the fact.

The Urgent Notice should contain details on:

 Work in progress at the time
 Time, place and nature of the accident
 Persons injured
 Property damages
 Nature of injuries and damage, and estimation of severity
 Immediate corrective actions to be taken.

The report should be factual and avoid hearsay, assumptions and preliminary conclusions.
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6.5 Investigation Process

6.5.1 General:

The accident/incident investigation process should comprise the following consecutive

stage:
 Establish an Accident Investigation Team
 Investigation Preparation
 Fact Finding
 Analysis of Fact Findings
 Recommendations
 Investigation Report
 Management Endorsement
 Implementation of Recommendations
 Distribution of Investigation Findings
 Follow-up

6.5.2 Accident Investigation Team:

Investigations should be carried out as soon as possible after the accident, because
the quality of evidence can deteriorate rapidly with time.

Therefore, the Site Manager shall immediately establish an Accident Investigation

Team and has a prime responsibility for accident investigation, and shall appoint the
member of Accident Investigation Team, according to the extent and severity of the
accident.

In principle, the Accident Investigation Team consists of CONTRACTOR and relevant

Subcontractor's Site Managers, Construction Superintendent, Site HES Coordinator
and Supervisors and Line Supervisors and/or Foremen responsible for the work.

6.5.3 Investigation Preparation:

Background information such as that listed below should be obtained at the start of the
investigation:
 Location Plans and drawing concerned
 General Work Procedures for the type of work involved
 Work Execution Procedure for the specific work
 Records of instruction/briefings give at TBM, etc.
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 Records of work permits concerned, if any

 Work organization (command structure and persons involved)
 Personal data of the persons involved in the accidents.

6.5.4 Fact Finding:

a) General
The Object of Fact Finding is to collect as many facts as possible, which may help
understanding of the accident and the events contributing to and the events
surrounding the accident.

The scope of an investigation can be divided into five areas:

 Environment
 Equipment
 Procedures
 People
 Organization

In each of these areas, conditions, actions or omissions may be identified which

could be factors contributing to the accident or to subsequent injury, damage or
loss.

However, the conditions underlying these causes may also need investigating. The
principal Fact Finding sources are:
 Observation at the scene of the accident
 Interviews with personnel concerned
 Written instructions and procedures
 Records
 Reports of specialist's investigations and views

Information should be verified wherever possible. In particular, it should be noted

that statements made by different witnesses may conflict, and supporting evidence
may be needed.

The information shall be carefully examined and systematically analyzed by the

Investigation Team.
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In order to ensure that all the facts are uncovered, the broad questions of "what",
"why”, "when", "how", "where" and "who" should be utilized.

After fact finding it should be possible to:

 Give a precise description of the accident, its background and the events
leading up to it
 Describe working environment
 Identify the equipment in use, its capabilities and any failures
 Describe the locations of key Personne1 and their actions immediately before
the accident
 Describe all pertinent: instructions
 Comment on response to the accident (rescue, shutdown, fire fighting, etc.)
 Make an inventory of all the consequences of the accident, (injury, damage
and loss).

b) Inspection of the Accident Location

Important evidence can be gained from observations made at the scene of the
accident, especially when witnesses are not available, physical evidence from the
scene of the accidence will be helpful in investigation.

Furthermore, physical evidence will help victims and witnesses to recall what
happened when their memories are unclear.
Photographs and/or video film should be taken to assist in the investigation. Items
to be checked include:
 The condition of the load-bearing surface
 Accessibility/evidence of congestion
 Illumination of the location/site
 State of housekeeping
 The condition of all equipment/facilities
 Presence (absence) of warning signs/notices
 Effect of weather
 Presence of witnesses
 Presence of unauthorized people
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c) Interviews
Victims, witnesses, and colleagues may have different impressions of what
happened.

Therefore, interviews shall be conducted individually so that witnesses are not

influenced by each other. Witnesses, interviews should be conducted step by step
sequentially based on the facts available.

Interviewer comments, leading questions, or accusations shall be avoided. The

interview information should be recorded, without any modification by the
interviewer's preconceptions.

d) Records, Drawings, Written Instructions and Procedures

Records, such as inspection and maintenance, records, of equipment and facilities,
HES Training records, work permits, measurements of environmental conditions
may provide information relevant to the investigation.
Written instructions and procedures provide evidence of pre-planning and
individual responsibilities.

The investigation should try to establish the extent to which written procedures and
instructions were understood and acted upon, as these can indicate the
effectiveness of training and supervision.

Experience shows that procedures are frequently not fully applied in practice.

e) Personal Data
Personal Data of persons involved in the accident:
 Name/Age/Sex/Family Status
 Occupation/Experience
 Type of Licenses/Certification

6.6 Analysis of Accident Cause

6.6.1 Purpose:

The purpose of the analysis is to identify the sequence of critical events, underlying
causes of the accident and to find measures to prevent a recurrence of similar
accidents.
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6.6.2 Cause of Accident:

The Causes of accidents consist of immediate causes, which could have contributed
directly to the accident, and underlying basic causes such as the lack of management,
and human factors and job factors, and/or a combination of these.

Thus, the causes of an accident are usually complicated. Even when the cause seems
to be obvious, the investigation should remain skeptical until all possibilities have been
investigated.

The Investigation Team shall look for any immediate causes, which could have
contributed directly to the accident.

In addition to the immediate causes above, the basic/ underlying causes, which are
“causes behind the causes”, also shall be investigated. The basic/underlying causes
are defined as personal factors such as inadequate capability lack of knowledge, etc.,
and job factors such as lack of management, inadequate leadership and/or
supervision, inadequate engineering, etc.

6.6.3 Investigation Analysis Meeting:

The Accident Investigation Team shall have meetings to analyze and identify the
causes of accident using the survey records of the location, interviews with the all
witnesses, documents concerned, etc., and establish rectification plans, and
summarize recommendations to prevent recurrence of similar accidents.

Any assumptions made during the analysis should be clearly identified in the report.
The progress and results of the meetings shall be recorded.

6.7 Recommendations

Recommendations shall be made to identify action to prevent recurrence. All recommendations

shall be in the form of practical Action Plan, which clearly indicate the action party so that
effective follow-up can is achieved. Deadlines for action should be suggested for subsequent
endorsement by the action party.

The recommendations to eliminate basic and immediate causes and to improve HES
management shall be also reported and explained to the Client, and when required to the local
authorities for their approval.
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6.8 Reporting

If happen accident/incident at the workplaces that impacted/resulted some cases; its cases be
compiled to the significant impacted of the accident/incident with recorded in 1 case only.

6.8.1 Accident and Incident Announcement:

Immediately after the occurrence of an accident or incident, first report shall be

informed to the Project Manager and HES Management Office of CONTRACTOR.

6.8.2 Accident/Incident Investigation Report:

The Accident Investigation Report shall present the findings and recommendations of
the Investigation Team. The items to be reported are given in "Accident/Incident
Investigation Report".

The Site Manager shall be responsible for the accident reports prepared by the
Accident Investigation Team. Before submission the Investigation Report should be
reviewed by the Site Manager to check on the completeness of the investigation and
for endorsement of the recommended actions.

6.8.3 Near-Miss Report:

Any Near-Miss case shall be reported to the Project Manager and HES Management
Office after the investigation of the event.
Reference: Near-Miss Report and Traffic Accident Report

6.8.4 Environmental Accident:

All accident related to environmental i.e.; oil spill or hazardous waste spill, and pollution
of the environment which has/could have influence on the environment shall be
reported and compiled to the monthly HES Performance Statistic.

6.8.5 Monthly HES Performance Reports:

Monthly Accident Incident Status report shall be compiled using "Monthly HES
Performance Statistic Report"

This report shall be prepared by the Safety Officer, reviewed by the Site HES
Coordinator. and issued by the Site Manager to the Project Manager and the HES
Management Office of CONTRACTOR.
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6.9 Records

All investigations, information, recommendations and implementation of recommendations,

etc., concerning the accident shall be recorded and retained at the Site Office. They shall be
compiled systematically and sequentially.

The record includes, but is not limited to:

 First Information (informer, date, time, receiver)
 First Actions Taken
 Establishment of Accident Investigation Team
 Records of all interviews
 Minutes of accident investigation meeting
 Recommendations for rectification
 Comments by the Client and/or Authorities

6.10 Distribution of Report

The HES Management Office of CONTRACTOR shall compile and register all
“Accident/Incident Investigation Report(s)” from the construction site offices.

The Safety Management Office shall report serious accidents to all construction sites in order
to call attention to measures for preventing similar types of accidents.

The “Monthly HES Performance Statistic Report” is used for analyzing the causes and
tendencies of accidents, and introduced into the annual HES statistics in the Corporate HES
Performance.

The HES Performance is distributed to all Managerial Personnel, and all undergoing projects
in construction sites.

7.0 VERIFYING DOCUMENTS

 HES Performance
 Accident/Incident Reporting
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8.0 APPENDICES

Appendix-1a Tabulation of Scheduled Charges for Disability Cases based on

OSHA and ANSI
Appendix-1b Chart of Scheduled Charge for Hand and Foot based on OSHA and
ANSI
Appendix-2 Accident/Incident Report Flowchart For Project

Attachment Form Report

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Appendix-1a (1/1)
TABULATION OF SCHEDULED CHARGES
or Loss of Members – Traumatic or Surgical (days)
FOR DISABILITY CASES BASED ON OSHA AND ANSI
Fingers, Thumb, and Hand
Amputation Involving Fingers
All or Part of Bone* Hand Thumb Index Middle Ring Little
Distal phalange - 300 100 75 60 50
Middle phalange - - 200 150 120 100
Proximal phalange - 600 400 300 240 200
Metacarpal - 900 600 500 450 400
Foot at wrist 3000 - - - - -
Toe, food, and Ankle
Amputation Involving All
or Part of Bone* Food Great Toe Each of other toes

Distal phalange - 150 35

Middle phalange - - 75
Proximal phalange - 300 150
Metatarsal - 600 350
Foot at ankle 2400 - -
Arm
Any point above elbow,
including shoulder joint 4500

Any point above wrist and 3600

at or bellow elbow
Leg
Any point above knee 4500
Any point above ankle and 3000
at or below knee
Impairment of Function
One eye (loss of sight), whether or not there is
1800
sight in the other eye
Both eyes (loss of sight) in one accident 6000
One ear (complete industrial loss of hearing), 600
whether or not there is hearing in the other ear
Both ears (complete industrial loss of hearing) in 3000
one accident
Unrepaired hernia 50
*If the bone is not involved, use actual day lost. The tuft of the distal bone of a finger or toe is
considered bone if it shows in X-Rays
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Appendix-1b (1/1)
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Appendix – 2
ACCIDENT/INCIDENT REPORT FLOW CHART FOR PROJECT

Discoverer of Accident/Incident:
1. Fatality, LTI
2. RWDC,Medical Treatmen,
3. First Aid, Nearmiss,
4. Environmental Accident

SUB-Subcontractors

Local Authority: CONTRACTOR Site CLIENT:

 Police Project  HSE Representative
 Municipally  Project Management
 Site Manager
 Fire Brigade  Fire brigade
 Site HSE Coordinator
 DEPNAKER  Security
 Management Line
 ERT

Hospital Clinic

Medan Project Office

 Project Manager
 Management Line

CONTRACTOR Home
Office
 HSE
 Management Line
 Top Management

Note:
: Coordination Line
: Reporting Line
: Investigation Line
: Supporting