EMERGENCY RESPONSE PROCEDURE/ REPORT/ ACCIDENT
From our interview with the secretary of safety and health committee of FKK, Miss Hajatun
Rabani binti Ahmad Razif. Till today, there are only one major accident which are the laboratory
ceiling dropped but it did not cause any injuries. Most common accident occurs in the laboratory are
broken beakers which mostly caused by mishandling. There are no serious injury due to accidents in
the laboratory that are reported until today.
Provided below is the form used to report any accident occurs in the laboratory, the first
person that need to be informed first are the lab assistant to measure the severity of the accident
for further action needs to be taken. From the form, we can see that any accident are treated very
seriously in spite of their severity. This is to comply with the FKK safety and policy which is to
continually improved compliance with OSH legislations and effective implementation of FKK UiTM
OSHMS by achieving and maintaining certification to OHSAS 18001:2007 and MS1722:2011.
Also provided below is the standard emergency procedure when fire occurs in the laboratory,
this procedure must be shown and followed by all personnel that works in the laboratory to prevent
chaos and reduce risk of injury in case of fire occurs.
FACULTY OF CHEMICAL ENGINEERING
THINGS TO DO DURING FIRE & EMERGENCY EVACUATION
Whenever the fire alarms/strobes are activated, occupants must evacuate the building
and reassemble at designated assembly point – CAR PARK AREA.
1. Follow instructions from Emergency Personnel or Emergency Evacuation Procedure.
2. Switch Off all the electrical items & Close your office door. If time and conditions permit,
take with you important personal items only such as car keys, purse, medication, glasses.
3. REMAIN CALM, WALK QUICKLY & QUIETLY (do not run) to the nearest
staircase/Emergency Exit. Do not push or crowd. DO NOT USE LIFTS/ELEVATORS
4. FOLLOW the Emergency Evacuation Route Signage to the assembly point – CAR PARK
AREA.
5. Check doors for heat before opening. (Do not open door if hot !.)
6. Assist people with disabilities.
7. Keep roadways and walkways clear for emergency vehicles.
8. DO NOT RETURN until emergency personnel give the ‘all clear” signal. Silencing of the
alarm does not necessarily mean the building can be reoccupied.
EMERGENCY CONTACT NO :
1. Unit Keselamatan - 03-5544 3999 (Hotline)
03-5544 2157
4. Bomba Shah Alam
– 03-5519 4444
2. Pusat Kesihatan – 03-5544 3627/3833
5. Police Station Section 6
– 03-5519 4622
3. Bomba/Polis/Ambulan –
999
6. Hospital Besar TAR, Klang – 03-3372 3333
Dean,
FAKULTI KEJURUTERAAN KIMIA
FACULTY OF CHEMICAL ENGINEERING
THINGS TO DO DURING FIRE & EMERGENCY EVACUATION
Responsibilities of Lecturer/Technician during Class/Lab Session:
1. Direct students to follow Fire & Emergency Procedures or emergency personnel.
2. Close classroom doors/windows and turn off lights
3. Ask student to REMAIN CALM, WALK QUICKLY & QUIETLY (do not run) to the
nearest staircase/Emergency Exit. Do not push or crowd. DO NOT USE
LIFTS/ELEVATORS
4. FOLLOW the Emergency Evacuation Route Signage to the assembly point – CAR
PARK AREA
5. Check doors for heat before opening. (Do not open door if hot !.)
6. Assist people with disabilities.
7. Keep roadways and walkways clear for emergency vehicles.
8. Account for all students when arrive at the assembly point
9. Inform emergency personnel/administrator immediately if student(s) is/are missing.
10. Stay with class.
11. DO NOT RETURN until emergency personnel give the ‘all clear” signal. Silencing of the
alarm does not necessarily mean the building can be reoccupied.
EMERGENCY CONTACT NO :
4. Unit Keselamatan - 03-5544 3999 (Hotline)
03-5544 2157
4. Bomba Shah Alam
– 03-5519 4444
5. Pusat Kesihatan – 03-5544 3627/3833
5. Police Station Section 6
– 03-5519 462
6. Bomba/Polis/Ambulan –
999
7. Hospital Besar TAR, Klang – 03-3372 3333
Dean,
FAKULTI KEJURUTERAAN KIMIA
SH.UiTM.FKK (P.09).AIIR
FACULTY OF CHEMICAL
ENGINEERING
UNIVERSITI TEKNOLOGI MARA
ACCIDENT & INCIDENT REPORTING AND INVESTIGATION FORM
No:
Instructions
9.
10.
11.
12.
13.
14.
Report
Please write legibly and send form to Faculty of Chemical Eng. Safety & Health Subcommittee (SOSHCo)
Use one form per accident / incident.
To be filled by Lecturer/Supervisor and Lab. Manager.
All accidents / incidents to be reported within 24 hours.
Fatal / Serious accident must be reported immediately to the Dean
Do not dispose evidences related to accident / incident.
PART A INFORMATION ABOUT INCIDENT (To be filled by Lecturer/Supervisor In
Charge/Lab Manager)
SECTION 1: DETAILS OF INCIDENT
Major InjuryMinor Injury
condition
Other
First Aid
Date:
Damage only
Time
(24-hour clock)
Near miss/unsafe
Location (eg. Chemistry
Lab, Building 5, Level 6)
Describe how the incident occurred: (use a separate sheet if necessary)
List any machinery or equipment, protective clothing or equipment being used
SECTION 2: DETAILS OF INJURED PERSON (IF APPLICABLE)
Full Name (Prof/Dr/Mr/Mrs/Ms/Miss)
Home address:
Contact number:
Staff
Contractor
Visitor
Staff/Student Number
Hours worked on day of incident
UG Student
PG StudentVisiting Student
Position:
From:
To:
(24-hour clock)
OSH.UiTM.FKK (P.09).AIIR
Describe type and position of injury: (eg left leg bruised, cut to right index finger etc)
Types of accident / incident
Type of injury
Agency of injury
Cut
Slip / Trip
Electrical
Exertion
Laceration
Strain
Scratch
Sprain
Laboratory
Equipment
Struck / Hit
Manual Handling
Knock
Sharp object
Bruise
Puncture
Amputation
Burn
Knife/blade
Door
Chemical
Hot object
Furniture
Glass
Slippery
Floor
Tools
Ladder / Stairs
SECTION 3: DETAILS OF WITNESS(ES) (use a separate sheet if necessary)
Name of person in charge at the location of
incident
Staff:
Position:
Contact no:
Name of witness
Staff/student no:
Position:
Contact no:
SECTION 4: DETAILS OF TREATMENT
Details of treatment received: (eg. wound cleaned with non-alcohol wipe and sterile
dressing applied)
1st aider
Health Center
Hospital
Likelihood of absence from work None
GP
Self-treatment
Less than 3 days
None required
More than 3 days
SECTION 5: CAUSE OF ACCIDENT
Factors responsible for the accident / incident. Mark
1. Inadequate / excessive
illumination
2. Inadequate tool / equipment /
material
3. Inadequate / improper protection /
guard
4. Inadequate physical ability of
person
5. Inadequate instruction
6. Inadequate maintenance
17. Failure to warn
25. Using defective tool /
equipment / materials
26. Personal protection not
properly worn
27. Servicing equipment in
operation
28. Poor housekeeping /
disorderly workplace
29. Horseplay / abuse / misuse
18. Failure to secure
30. Safety devices removed
13. Improper dress
14. Lack of knowledge / training
15. Lack of skill
16. Lack of concentration
21. Under haste
22. Operating equipment without
authority
23. Operating at improper speed
12. Improper lifting
24. Safety device made inoperable
10. Improper loading
34. Unsafe attitude / practice
35. Others
SECTION 6: PERSON COMPLETING PART A
Signed:
Date:
Print Name:
Contact Number:
FOR SOSHCO OFFICE USE ONLY
SECTION 7: ACTIONS TAKEN FOLLOWING INCIDENT
Immediate actions taken to rectify the situation:
Long term actions needed to prevent recurrence for continual improvement.
ACTION
DATE COMPLETED
INITIALS
SECTION 8: INJURY TYPE
□ Struck by moving or flying object
□ Struck by moving vehicle
□ Drowning or asphyxiation
□ Exposure to an explosion
□ Exposure to fire
□ Injured while
handling/lifting/carrying
□ Injured by an animal
□ Slip, trip or fall on same level
□ Reportable diseases
□ Fall from height ( ______ metres)
□ Other ______________ (specify)
□ Contact with moving machinery or material being
machined
□ Struck against something fixed or stationary
□ Trapped by something collapsing or overturning
□ Exposure or contact with a harmful substance
□ Contact with electricity or electrical discharge
□ Handling glass or sharps
□ Physically assaulted by another person
□ Slip, trip or fall on stairs
□ Contact with hot/cold surface
□ Hand tools
□ No injury incident
OSH.UiTM.FKK (P.09).AIIR
NADOPOD? Yes / No
JKKP FORM NO: (6, 7, 8, 9, 10)
SECTION 9: BODY PARTS
L/R
Ankle
L/R
Foot
L/R
Lungs
L/R
Arm
L/R
Groin
L/R
Neck
L/R
Back
L/R
Hand / Wrist
L/R
Nose
L/R
Ear
L/R
Head
L/R
Rib / Chest
L/R
Eye
L/R
Heart
L/R
Shoulder
L/R
Face
L/R
Jaw
L/R
Toe
L/R
Finger
L/R
Leg
L/R
Other – Specify
SECTION 10: DIRECT CAUSE(s) – Check all that apply:
UNSAFE BEHAVIOR
UNSAFE CONDITIONS
Operating or using equipment without authority
Failure to secure against unexpected movement
Operating or working at an unsafe speed
Removing or bypassing safety devices
Using defective tools or equipment
Using tools or equipment improperly
Taking an unsafe position or posture
Failure to properly lock-out or tag-out equipment
Starting equipment without warning
Failure to wear personal protective equipment
Unprofessional behavior - Distracting, teasing, horseplay
Other - specify: _________________________________________
Missing or inadequate safety guards and devices
Missing or inadequate warning signs or systems
Fire and explosion hazards
Poor housekeeping
Protruding object hazard
Pinch-point or other clearance hazard
Hazardous atmospheric or other environmental hazards
Unsafe material placement and storage
Defective tools and equipment
Sub-standard construction or structure
Improper work attire
Other - specify _______________________________
SECTION 11: ROOT CAUSE(s) – Check all that apply:
PROCEDURES
None exists
Not followed or enforced
Difficult to use or understand
Not current or wrong
Other - specify:
COMMUNICATIONS
TRAINING
None exists or incomplete
Inadequate or not timely
Not understood or demonstrated
No refresher or not reinforced
Other - specify:
MANAGEMENT SYSTEM
OSH.UiTM.FKK (P.09).AIIR
No method available
Inadequate method
Misunderstood – written
Misunderstood – verbal
Not timely
Other - specify:
Lack of policy or administrative controls
Inadequate employee enforcement policy
Poor training / communication methods
Lack of knowledge / training resources
Lack of accountability
Other - specify:
AUDITS & INSPECTIONS
HUMAN FACTORS
Not performed or infrequent
Inadequate scope or lack depth
Hazard(s) not identified – no Job Safety Analysis
Corrective action incomplete or not timely
Other - specify:
Poor attitude or state of mind
Physical / mental stress
Job knowledge / skill deficiency
Poor work environment or conditions
Other – specify:
SECTION 12 : OUTSIDE TREATMENT (if yes, complete below):
Name of Doctor/Hospital:
Address of Doctor/Hospital:
Contact No:
Is this the first time this hazard or near miss has been reported?
Yes
No
Unsure
If this has been reported previously, when was it reported and to whom?
What actions have been taken?
Actual Days Lost:
Date recorded in Accident Book FKKab101
Signed:
Print Name & Position:
Date completed
NOTE: THE FORM IS TO BE SENT TO THE FACULTY ADMINISTRATION OFFICE
IN DUPLICATE COPIES WITHIN 24 HRS OF THE INCIDENT