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Helpdesk Form Namibia
English (US)
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English (UK)
English (US)
Français (BE)
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Report an incident
Full Name
*
Company Name
Email Address
*
Phone Number
Creator's Department
*
(CMB) Operations
(CMB) Guards
(CMB) Maintenance
(Contractors) Contractor 1
(Contractors) Contractor 2
(Third party) Visitor
(Third party) Driver
(Third party) Supplier
Incident Description
*
Attach File
Incident Categories
*
Personal Safety
Process Safety
Security
Fire
Complaint
Environmental
Damage
Unit interuption
Traffic
Other incident
Select all options that apply
Incident (Personal Safety)
NM (Near Miss)
FAC (First Aid Case)
MTC (Medical Treatment Case)
RWI (Restricted Work Incident)
LWI (Lost Work Incident)
FAT (Fatal Accident - Death)
Third-party incident
Non-recordable injury
Unsafe act by employee
Unsafe act by third party
Unsafe condition
Incident (Security)
Security Incident
ISPS Incident
Incident (Fire)
Fire
Self-Heating
Smoke Development
Explosion
Insulation Smoldering
Electrical Fire
Incident (Environmental)
Environmental - General
Minor leakage
Exceeding internal requirement
Exceeding permit requirement
Internal odor
External odor
External visual disturbance
Near miss
Unsafe act by employee
Unsafe act by third party
Unsafe condition
External noise
Incident (Process Safety)
Near miss
Significant gas release
Minor gas release
Solid material release
Liquid released on board ship
Liquid release to unprotected ground
Liquid release to unprotected ground (>1 barrel)
Liquid release to unprotected ground (<1 barrel)
Liquid release on protected ground (contained)
Liquid contained in pre-installed drip tray
Liquid release to sewer / separator
Liquid release to surface water
Steam / condensate leak
Firewater leak
Unsafe act by employee
Unsafe act by third party
Unsafe condition
Incident (Complaint)
Internal complaint
External complaint to third party
External complaint from third party
Incident (Damage)
Third party damage
Inter-contractor damage
General damage
Damage due to E&I failure
Employee-caused damage
Third-party-caused damage
Damage due to mechanical failure
Damage during transport
Damage - cause/responsible party unknown
Damage due to weather conditions
Incident (Unit Interruption)
DCS problem
Unit Trip
Unit Shutdown
Unit Upset
Incident (Traffic)
Violation of traffic rules on site
Incident (Other)
Site
*
Arrandis
Farm 58
NH3 terminal
Jetty
Corridor Arandis to Farm 58
Corridor Farm 58 to NH3 terminal
Corridor NH3 terminal to Jety
External
Mobile Refueller 1
Mobile Refueller 2
Mobile Refueller 3
Mobile Refueller 4
HRS Antwerp
Area/Unit
PV farm
H2 production
Location
Equipment Tag Number
Immediate Actions Taken
Witness
Reporter's Recommendations and Comments
Trespassing Essential Safety Rules
Type of Essential Safety Rule
Work permit
Confined space
Equipment isolation - Lock out / Tag out
Fall protection
Suspended loads
Smoking
Transport
Shutdown of critical equipment
Alcohol and drugs
Zoned areas
Trespassing Process Safety Rules
Type of Process Safety Rule
Management of Change (MOC)
Drain
Double Barriers
Procedure
Alignment
Decommissioning
Commissioning
Material
Submit