1. Non Accidental Death Non-accidental death is the death of a company or contractor employee due to suicide or a non-work related illness occurring in the work environment i.e death in company or contractor premises. NAD has to be reported to the relevant supervisor, medical personnel and HSE department as soon as possible within 24 hours. NAD shall be investigated and line has to initiate the investigation and submit NAD report within one month. Line manger or director is the incident owner. When you conduct NAD investigate ask yourself 5 questions 1.Have all possible work related exposures that could have contributed to the cause of death been excluded? 2.Was the fitness to work requirements met? 3.Was the MER requirements met? 4. Were all other relevant requirements of HSE control framework to protect the individuals’ health from cause of death in place? 5. Was a PDO doctor part of the investigation team?

2. Non Accidental Death - Examples CaseClassification Employee commits suicide at work but due to work related issues Work related fatality Employee commits suicide at work due to personal home pressures NAD Employee falls ill at site but dies later in hospital due to same illness NAD Employee has a non work related illness (e.g. stroke, whilst resting off duty in the work camp NAD Employee dies at home from non work related illness Death in service Employee dies from on work related illness whilst in hotel away on business Death in service Employee dies from a fatal occupational illnessWork related fatality

3. Non Accidental Death - Challenges 1.Remain a challenge in PDO concession area, mostly among contracting community 2.No known prior medical condition(s) in 1/2 of the NADs. 3.Most appeared to have valid FtW certificates. 4.No significant findings during routine 2 yearly medical. 5.No appropriate follow up chronic medical conditions and health risk factors in Many of the employee. 6.Life style issues, employees denial of medical problems and ignorance of medical advice 7.The common risk factors include smoking, HTN, high cholesterol and diabetes 8.Issues with return to work following significant illnesses.

4. NAD – Challenges cont. 9.Lack of Proactive leadership by contract holders on OH  inadequate in verifying compliance with OH specifications by the contractors (e.g pre- employment medicals, medical facilities, HRAs, camps standards etc). 10.Recent observed incidents of suicides. 11.Inappropriate medical facilities in some locations or rigs e.g. 12.Investigations often not solid conclusive with difficulties in conducting autopsy in many cases. 13.MER issues including competence of Contractors’ doctors and nurses, shortage of drugs and MER equipments. 14.Increased size of workforce - Over 55,000 workforce as oppose to the supervisors/contract holder’s ratio.

5. The main factors to NADs ChallengeCauses 1Pre-existing conditions HTN, Diabetes, High cholesterol level 2Individual behaviors and life style issues Lack of exercise, Heavy smoking, Over eating, obesity, etc. 3Attitude, culture and beliefs issues Bad beliefs, Fears, Ignorance of medical advice and denial. 4Non-compliance with FTW Standards and medical surveillance Issue of appropriate exams. 5Issues with return to work medicals Ignorance v/s fear of losing job 6Occasional no follow up of cases with chronic medical problems. Inappropriate follow up and care of chronic medical conditions 7Lack of health awareness Language diversity

6. NAD -Epidemiology  Over 80% are due to massive heart attack or other cardiovascular disease.  11% unknown  1% suicide  PDO and contractors’ death rate of 0.49 is well below the national rate of 3.1.  PDO and contractors’ death rate from cardiovascular diseases in 2008 was 0.35 per 1000 population.  The national death rate from cardiovascular diseases was 4.09 per 1000 population for Oman and 4.28 per 1000 population for India according to WHO data base.

7. Percentage distribution of the workforce (PDO and Contractors %Omanis%Expatriates Total Population PDO 77%23%6500 Contractors 49%51%>50000

8. NAD according to company PDO - 14% Contractor - 86% - 30% Oman - 65% India/Pakistan/Bangladesh - 3% Philippines - 2% Other countries

10. NADsTotal manhours (mln.)rate/mln hours 19981559.310.253 19991352.810.256 20001051.620.194 2001848.470.165 2002853.390.150 20031160.870.181 2004867.210.119 20051164.260.171 20061878.840.228 20071599.620.151 200821127.060.165 200917147.070.116 201016147.930.108 201113141.240.092 20127149.150.047 20139158.490.057 My apologies for late response.

12. Age distribution of NADs

13. NADs assessment against some demography and MHMS standards (Dr. Sawai review - 2008) No. of NADsPercentages Omanis / Non-Omanis7 / 1433.4% /66.6% PDO / Contractors3 / 1814.3% / 85.7% No HRA performed945% Pre-existing medical problems1155% Non-compliance to fitness to work (FtW)1047% Cases with significant life style issues945% Failure to properly follow up chronic medical problems 628.5% Medical emergency response (MER)525%

14. NAD - PDO Efforts  Over the years PDO has made much efforts in order to improve the well being of its workforce and to address health and lifestyle issues.  These efforts continues today and include:  The appointment of full time Head of OH in 2008 and the recent merger of OH and Medical Dept. as one Health Team – Nov. 2011 which ensures the implementation of Minimal health management STD.  The appointment of full time Public Health Advisor and full time Dietician /nutritionist in 2012  Improved working and living Conditions(permanent accommodation for contractors, PACs)  Annual 1 month OH Road Shows to educate workers on various health topics including life style  NAD reporting and investigations- All NAD are now being discussed at MDIRC

15. NAD - PDO Efforts cont.  OH plan  Conducted OH workshop for all HSE managers, Contract holders and PDO/Contractor medical professionals to increase OH awareness, within PDO concession area.  Training of doctors who provide FtW medical for contracting workforce and emphasize on the importance of compliance with FTW standards, the medical conditions which affect fitness to work and the follow up of high risk cases.  Just completed 5 days OH course by UAE/Irish University for 30 doctors.  Annual wellness walk and OH road shows in all interior locations.  Continue to play a leading role in OH in Oman. Provide advice, support and training to MoH, SQUH graduates.

16. NAD - PDO Efforts cont.  Dietitian / Nutritional services and wellness program.  The appointment of full time Dietitian to look after dietary aspect of welfare of the workforce by working with catering services to improve healthy diets. The goal is to reduce the increasing trends in lifestyle related medical conditions  Stepped up workplace wellness programs in order to improve the well being of the workforce and to address health and lifestyle issues through health promotion and health education presentation. Over 670 employees received dietetic consultations in 2013.  Introduced in-house exercise facility (GYM) to encourage employee to participate in regular exercise.

17. PDO Efforts - continue  Public Health and Employees’ Welfare  The appointment of full time Public Health Advisor, and Welfare (Employee assistance program) Officer to support Public Health activities and the welfare of contracting community /workforce.  Improvement of the workforce welfare- PAC accommodation and supervision of camp services and hygiene including catering services.  Review of the work-leave schedule for the contractors’ workforce. (Need enforcement)  Discussion underway to look into providing Employee Assistance Program (EAP) with focus on welfare of contracting community/workforce impacting on health

18. NAD - PDO Efforts cont.  Medical Emergency Response (MER)  All PDO health professionals are fully versed in MER, trained in ACLS, ATLS, and Exposure to other emergency response experiences.  Procedure in place to ensure all contractors’ nurses and doctors are well versed in MER and have valid ACLS/ ATLS.  Increased number of Designated First Aiders and introduction of the new AHA accredited First Aid course.  New fleet of ambulance is in place and 6 new paramedics have been trained to replace ambulance drivers.  Regular drills (Needs improvements)

19. 2014 planned activities.  Centralization of contractor medical services The phasing out of small clinics manned by single nurse and provide centralized facilities manned by doctors who will be able to follow up chronic medical conditions which increased risk of heart attack and other causes of sudden death.  Stepped up workplace wellness programs with the goal to reduce the increasing trends in lifestyle related medical conditions. This includes the smoking cessation clinic.  Enhanced implementation of smoking, Drug & alcohol policy.  Enhanced implementation evaluation of pre-employment and fitness to work medical evaluation in PDO and contractor workforce.