GI 6.

004, Supplement 1 - Near Miss Report

Form
INCIDENT DETAILS
Date: 24 April 2014 Time: 06:20 a.m Location/Plant/Equipment: Rabigh II
Dept: Civil GS Neotek Org.Code Division/Unit: Petro Rabigh Phase II

Description (Explain what happended use attachments if needed):

While driving along the road together with 15 passengers. Mr. Hamzah A. Al-Wesabi, a bus driver,
noticed white smoke coming from the engine compartment. He immediately pulled over, turn off the
bus and instructed workers to get out. After opening the hood, he discovered the smoke is due to an
overheating engine. He reported the incident instantly to the Supervisor and GS Neotek HSE
Department were informed also through a call and immediately response without delay around 06:30
a.m. Incident area was isolated with traffic cones and warning tapes. Trained flagman was also assigned
to control road traffic. Nobody gets hurt on what happened.

Driver: Hamzah A. Al-Wasabe
Driving License #: 2206907657 Expiry: 29-06-2018
Bus Plate #: 7020 EKA

ESTIMATE OF LOSS POTENTIAL (What injuries or losses might have occurred.)
Injuries:
Property/Equipment Damage:
Environmental Damage:
Others: MVA Motor Vehicular Accidents

ANALYSIS: (Why did it happen (List unsafe acts, unsafe conditions, wrong procedures/equipment or
other factors.)

1. The driver failed to perform a Pre-Start Checking before driving and possible deficiencies of
vehicle was not recorded.




CORRECTIVE ACTION (What must be done to prevent recurrence-list recommendations)

1. Daily checking of vehicles through the use of inspection checklist must be performed by the
driver prior to driving.
2. Preventive maintenance must be conducted regularly by a competent mechanic to ensure that
vehicle is in safe condition and safe to use.


REVIEWER INFORMATION
Reviewed By: Edgar Calano GS Neotek HSE Manager Date: 24 April 2014
Distribution: Original: Department Files 1 copy-Facility Division Head 1 copy-Area Loss Prevention(for serious near misses only)