1. HSE Investigation template and guidance Non Accidental Death (NAD)
HSE Incident Investigation guidance notes
HSE Investigation template and guidance Non Accidental Death (NAD)
First 4 slides are for guidance only and should be removed but used as reference, prior to draft 1 being submitted
Confidential - Not to be shared outside of PDO/PDO contractors

2. HSE Incident Investigation guidance notes
Process flow for investigations
Notification
Kick off
Investigation
Reporting draft
MSE3 IRC
Quality sign off
IRC/MDIRC
Minutes
PIM action close out
Confidential - Not to be shared outside of PDO/PDO contractors

3. HSE Incident Investigation guidance notes
Info to be established during Kick Off meeting
Remember guidance notes on bottom of slides
Incident Investigation Terms of Reference (ToR)
Investigation protocols - Documents to be used to investigation PR 1418
Incident Owner - Name and reference indicator
PIM No - XXXXXX
Investigation Team Leader - Names, reference indicators, role in investigation
Special terms - Special conditions/requirements of the investigation (e.g. joint PDO/contractor)
Subject Matter Experts – as required to be discussed during Kick Off meeting
Investigation deliverable - The team is responsible for investigating the incident and completing the following: Investigation report , MD/IRC presentation, and learning pack.
Previous NAD - Previous incident, similar incident, including PIM No from company
Immediate Cause – Bring to kick off meeting for agreement
Critical Factors – 1. 2.
Investigation Team Members- Names, reference indicators, role in investigation
Investigation Team lead Name Reference Ind, Role, attend the scene (yes / no), HII (ICAM) trained (yes / no)
Name Reference Ind, Role, attend the scene (yes / no), HII (ICAM) trained (yes / no)
If not HII (ICAM) trained the contractor is to provide Incident investigator, level of competency assurance from senior management.
NAD investigations should always include a medical professional.
Evidence repository must be provided electronically on data stick prior to MSE3 IRC
Note be aware that consequence management defaults may be applied where a non comprehensive investigation report is submitted for IRC, this may also be applied if there is not at least 1 member of the team who is up to date with PDO training course HSE Incident Investigation (HII) as a part of the investigation team.
Team Meetings:
The investigation team will regularly convene as directed by the investigation team leader and will depend on progress made in the investigation.
Deliverables/deadlines
Date of issuing initial notification of the incident with learning's First Alert to MSE 3
Date draft investigation report, slide pack ready for initial IRC with MSE 3 . Corrections/updates to be made. Date of first Tripod Tree
Date of directorate IRC panel Corrections/updates to be made.
Date of MDIRC will be held
The Investigation Team Leader will provide regular updates to the Incident Owner for the duration of the investigation. Any significant critical learning's shall made known to the Incident Owner and passed to MSE 3 for wider communication as soon as possible and shall not wait for the final report to be published
Confidential - Not to be shared outside of PDO/PDO contractors

4. HSE Incident Investigation guidance notes
Timetable to be communicated during kick off meeting
Incident classification, Critical factors, SME requirements, Timelines for reports
Rolling Days Action / Task
0 Notification received from MCOH
0-1 Initial Notification
1 Kickoff meeting
10* 1st Draft of report to MSE 3 representative  Review 1st draft return consolidated feedback
  2nd Draft of report to MSE 3 representative  Review of 2nd draft return consolidated feedback
21 Final revision for MSE IRC
23* MSE3 IRC
  Final report   QA / QC letter
30* Director IRC
42 MDIRC
* Escalation process milestones for not keeping to the timeline:
+3 days over due reminder 1 to Investigation Team Leader, HSE Team Leader and MSE 3
+5 days over due reminder 2 to Investigation team lead, HSE Team leader, MSE 3, MSEM and Director
Confidential - Not to be shared outside of PDO/PDO contractors

5. Non Accidental Death Name of Company Date of Incident

6. Name of Company and incident date
Incident details
PDO directorate/dept : (e.g. OSD /OSO/OSO4)
Contractor name/number : (subcontractor-contractor-PDO)/CXXXXXX
Incident owner : Name / Ref Ind of the Director
PIM ID : Number assigned in PIM
Location : Area / unit - (road/yard/station/rig/hoist/plant etc)
Incident date & time : (d/m/yr) / (24 hour clock) – advise if estimated
Incident type : Non Accidental Death (NAD)
Actual severity rating : 4P (as all NAD’s are already established)
Immediate cause of Death : Short description of what caused the death
Previous NAD : Include PIM number, short description of last (LTI/ NAD) of the contractor, this applicable to all contracts with PDO
Key Mgmt Failure : Key Management system failure from conclusion slide including ICAM number
No variation to the slide is allowed
Confidential - Not to be shared outside of PDO/PDO contractors

7. Name of Company and incident date
Key Information about the deceased
Name of deceased
DOB and age
Nationality
Marital status and number of children. Including their age and sex
Duration of service with the company:
Job title
Work schedule and date of last leave & leave cycle (Days off)
HSE trainings and site induction
Number of children must include their ages and what sex they are
Confidential - Not to be shared outside of PDO/PDO contractors

8. Name of Company and incident date
Summary Description of the incident: On
This should be free text writing and include the relevant facts explaining what happened to all the relevant parties in a short sharp factual paragraph that describes the incident.
The description should be in sufficient detail to allow a person who does not know anything about the incident to imagine it. It should only be about what happened and not why it happened. Include a short comment on emergency response.
Do not include investigation findings here, simply describe the incident as the investigation has shown it happened.
Confidential - Not to be shared outside of PDO/PDO contractors

9. Name of Company and incident date
Details of the Medical Emergency Response (MER) :
Medical Emergency Response (MER)
Yes/No
Time to arrival
Comments
Was 5555 called?
Was co-workers/bystanders involved initially?
Was First Aider(s) involved initially?
Was the Medic/nurse involved in MER?
Was a doctor involved in MER?
Was AED used and if so how long it took to start
What was duration of resuscitation?
(usually 30 min. minimum)
Was the deceased medevac (details)?
Other important comment(s)
Confidential - Not to be shared outside of PDO/PDO contractors

10. Name of Company and incident date
Past Medical history:
Yes/No
Details
Major surgery
Chronic Medical condition(s) such as Diabetes, high BP, Cholesterol, others
Allergies
Any Regular medications
Did the deceased attended the clinic or had any complaints within 2 weeks of his death during this work period?
Medical examination:
Yes/No
Date done
At PDO approved clinic
Outcome -Fit /unfit/comments
Was Pre-employment examination done?
Was fitness to work examination done?
Fit or unfit?
Was periodic medical examination done?
Was Framingham cardiac risk done?
……..% Framingham score
Was Cardiac stress test (TME) done?
Pre-existing Medical problems and Medications.
NOTE* Include any personal medical treatment arrangements done by individuals if known and applicable
Confidential - Not to be shared outside of PDO/PDO contractors

11. Name of Company and incident date
Life style and social characteristics
Yes/No
Comments (E.g. quantity)
Was the deceased an active person leading a healthy lifestyle?
Was the deceased known to practice good dietary habits?
Was the deceased known to do regular exercise activities?
Was the deceased known to be a smoker /consume alcohol?
Was the deceased known to have drug misuse or drug issues?
Was the deceased notably obese?
Weight ….………kg. BMI …………….
Was the deceased a quite/loner type of personality?
Was the deceased a friendly and always tend to mingle with other people?
Was the deceased noted to have changed of behaviour in the past 1 or 2 months before his death?.
Confidential - Not to be shared outside of PDO/PDO contractors

12. Name of Company and incident date
Work Environment:
Yes/No
Comments
Any known work environmental factors which could have contributed to the death?
Any known chemical exposure from working environment?
Any known biological exposure from working environment?
Any unusual work related stress/fatigue?
Any other adverse work issue(s) worth noting.
Accommodation:
Yes/No
Comments
Was he staying alone or with roommate/s?
Was ventilation / air conditioning adequate?
Room lighting adequate?
Water and sanitation adequate?
Was food provision adequate?
When clearing the deceased room, was any medicines or non-prescription drugs found?
Confidential - Not to be shared outside of PDO/PDO contractors

13. Name of Company and incident date
Contractual Health Management
(Find out about the health management in contracts within the direct working environment of the deceased)
Yes/No
Comments / Gaps
Are all health risk assessments (HRA) carried out and completed?
Are all work hazards exposure are being monitored and managed?
Are health support and controls provided? (In compliance with SP-1230, 1232) E.g. Pre- employment, fitness to work, regular check up and general medical care and follow up.
Are regular health awareness and education provided to all employees?
Is MER plan available and regular drills conducted?
Include dates and content of drills
Are health activities included into the annual HSE plans and are they monitored by both contractors and PDO CH’s?
Does your accommodation / camp comply with SP-1243?
Ensure evidence of health risk assessments specific to deceased role is provided
Confidential - Not to be shared outside of PDO/PDO contractors

14. Name of Company and incident date
Conclusions:
Immediate Cause of Death
Underlying Causes of Death
Management system failure:
MSF Ref No #
ICAM Mgt System Failure Description
Justification for Management System Failure cited
Ensure you use ICAM when inputting Management System Failures
Immediate Cause of Death: As per Doctors reports
Underlying causes: Consider ICAM to assist in identifying potential underlying causes other than health
Management system failures: Always consider multiple options here. DO NOT just put a MSF without adequate justification

15. Name of Company and incident date
Key investigation findings: (List all the important findings) 1 2 3 4

16. Name of Company and incident date
Immediate actions taken if any:
No.
Actions
Date of action
Status 1 2 3
Immediate actions taken include all those reported to have been taken and completed within one week of the incident in a table.
Report the five most important immediate actions to prevent a reoccurrence in the future. These may be tracked for completion by the MSE team and reported to MDIRC.
*Immediate actions must be completed within 7 days of the incident
Confidential - Not to be shared outside of PDO/PDO contractors

17. Name of Company and incident date Recommendations(Actions)
Remedial Action / Recommendations:
No.
Recommendations(Actions)
Target Date
Action Party
(Contractor)
PIM Action Party (PDO)
PIM action No.
Status
Open/
Closed
Post action verifier
for PIM 1 2 3
Report the most important remedial actions to prevent a reoccurrence in the future first, these may be tracked for completion by the MSE team and reported to MDIRC.
You must provide a PIM action number as evidence that all actions have been uploaded into PIM
Confidential - Not to be shared outside of PDO/PDO contractors

18. PDO Second Alert Photo explaining what was done wrong
Date: Incident title: NAD
What happened?
Short description of what happened
Your learning from this incident..
(This must solely relate to the people at risk of harm or people at risk of causing the harm)
Learning points for them from the investigation
Photo explaining what was done wrong
Photo explaining how it should be done right
No names or detail of company to link this to any recent specific incident
Strap line – should be the key (keep short and memorable )

19. Name of Company and incident date
Management self audit - CHECK List to confirm
Yes/No 1
Do you report and investigate all occupational illnesses and NADs? 2
Are all your staff up to date with their periodic medical check and/or fitness to work? 3
Are all PDO specific fitness to work medical examinations conducted by PDO approved clinics?
and do your medical staff review the submitted reports to confirm conformance to PDO standards? 4
Are all employees with chronic medical conditions such as diabetes, high Blood Pressure etc being followed up appropriately? 5
Do you conduct regular health awareness to your staff? And specifically do you encourage your staff to seek medical help if feeling unwell? 6
Do your medical staff get approved by PDO medical department prior to deployment to PDO sites? 7
Does your medical staff attend regular continuous medical education and have valid MOH license and ACLS certification? 8
Do you ensure calibration of Medical equipments including AED and carry out daily ambulance inspection ? 9
Do you have Medical Emergency Response (MER) plan and do you conduct medical drills? 10
Do you have a clear Alcohol and drugs policy? 11
Does your medical service submit to PDO the monthly health performance report? 12
Is health management within the direct working environment of the deceased meeting Company standards? 13
Are health activities included into the annual HSE plans?
Confidential - Not to be shared outside of PDO/PDO contractors

20. Name of Company and incident date
Sequence of events, during and post incident response – Timeline
No.
Date
Time
Description of event 1 2 3 4 5 6 7 8

21. Date attended HII training
Investigation Team Members- Names, reference indicators, role in investigation
Name
Ref. Ind
Role
Attended the scene
Yes / No
HII* trained
Date attended HII training 1
Investigation Team Lead 2 3 4 5 6 7 8 9 10
*HII – HSE Incident Investigation
A list of team members starting with the investigation LEAD
For contractor related incidents this MUST be led by them and NOT by PDO. PDO staff may be required to support the investigation team.