Incident and Process Safety Event Report Form
v2.3
Purpose. Used by any worker to report an injury, near miss, hazard, loss of containment, safety system activation, safe operating limit excursion or environmental event on the shift it occurs.
1.When to use this form
Complete this form for every injury, illness, near miss, hazard, loss of containment of any quantity, safety system activation, emergency shutdown, excursion beyond a safe operating limit, alarm flood, spill outside a bund, environmental exceedance and property damage. The form must be completed before the end of the shift and given to the shift supervisor, who must enter it in the incident and process safety event register.
2.Immediate actions
Make the area safe and bring the process to a safe state first. Follow the abnormal situation procedure and the emergency response plan where they apply. Preserve the scene, the trends and the sequence of events for a serious event until the Process Safety Manager releases them.
3.Describing the event
Describe the sequence of events, the plant and chemicals involved, the quantities released or the variable and its value, the alarms that occurred and the actions taken. Record facts, not opinions about blame. Attach trends, photographs and the control system event log where available.
4.Classification
The shift supervisor will classify the event by type and by actual and potential severity using the process safety event tiers and the risk matrix. Events with high potential severity must be escalated to the Production Superintendent and the Process Safety Manager immediately and notified to the regulator where the regulations require.
5.Follow up
The Process Safety Manager will decide the level of investigation, appoint the investigation lead and track actions to closure in the register. Learning from the event will be shared at the shift pre-start meetings on every panel.