2002 26 lti’s in 6 months what are we going to learn? what should we do differently?

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20022002

26 LTI’s in 6 months26 LTI’s in 6 months

What are WE going to learn? What are WE going to learn?

What should WE do differently?What should WE do differently?

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26 LTI’s: 1/Jan-29/Jun 200226 LTI’s: 1/Jan-29/Jun 2002

1 1 Broken Finger 01 Jan Broken Finger 01 Jan

2 2 Broken Finger 03 JanBroken Finger 03 Jan

3 3 Broken Arm 24 JanBroken Arm 24 Jan

4 4 RTA Ruptured spleen 06 FebRTA Ruptured spleen 06 Feb

5 5 Broken Leg 23 FebBroken Leg 23 Feb

6 6 Back Injury 09 MarBack Injury 09 Mar

7&87&8 RTA Neck Injury &RTA Neck Injury &

broken arm 13 Marbroken arm 13 Mar

9 9 Broken Finger 25 MarBroken Finger 25 Mar

10 RTA Fatality 03 Apr10 RTA Fatality 03 Apr

11 11 Finger Amputation 05 AprFinger Amputation 05 Apr

1212 Elbow Dislocation 07 Apr Elbow Dislocation 07 Apr

1313 Crushed Finger 20 Apr Crushed Finger 20 Apr

1414 Broken Finger Broken Finger 28 Apr28 Apr

1515 Broken Hip Broken Hip 29 Apr29 Apr

16 16 Broken ArmBroken Arm 02 May02 May

17 17 Finger Amputation Finger Amputation 19 May19 May

18 RTA Fatality18 RTA Fatality 24 May24 May

19 19 Broken ArmBroken Arm 28 May28 May

20 20 Broken NoseBroken Nose 25 May25 May

21 21 Eye InjuryEye Injury 29 May29 May

22 22 Broken FingerBroken Finger 01 Jun01 Jun



25 25 Broken ArmBroken Arm 22 Jun22 Jun

26 26 Crushed FingerCrushed Finger 29 Jun29 Jun

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Common FindingsCommon Findings

• Hazards not identified Hazards not identified • Lack of effective supervisionLack of effective supervision• Using the wrong tools Using the wrong tools • Not following rules/proceduresNot following rules/procedures• Poor communication (Language barrier ?)Poor communication (Language barrier ?)• Behaviour & attitudeBehaviour & attitude• Lack of concentrationLack of concentration• Time pressure (hurry to finish the job)Time pressure (hurry to finish the job)

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LTI 1: Broken FingerLTI 1: Broken Finger 1-Jan1-Jan

What happened?:What happened?:Finger trapped between bucket and rock breaker whenFinger trapped between bucket and rock breaker whenoffloading the bucket from the trailer.offloading the bucket from the trailer.

Result:Result:• Broken fingerBroken finger• 3 weeks lost work3 weeks lost work

Learning:Learning:• Wrong hand placementWrong hand placement• Poor positionPoor position• Poor communicationPoor communication

Could this be avoided?Could this be avoided?

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LTI 2: Broken FingerLTI 2: Broken Finger 33--JanJan

What happenedWhat happenedPipe spinner (heavy tool hanging from a cable) swung back Pipe spinner (heavy tool hanging from a cable) swung back and trapped the floorman’s finger.and trapped the floorman’s finger.


Learning:Learning:• Improper positionImproper position• Wrong hand placementWrong hand placement• Absentminded/UnfocusedAbsentminded/Unfocused


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LTI:3 Broken Arm LTI:3 Broken Arm 24-Jan24-Jan

What happened?:What happened?:A rigger placed his arm into the recess of the craneA rigger placed his arm into the recess of the craneoutrigger as it was being retracted. His arm was crushed.outrigger as it was being retracted. His arm was crushed.

Result:Result:• Broken armBroken arm• 6 weeks lost work6 weeks lost work

Learning:Learning:• Wrong position (rigger)Wrong position (rigger)• Wrong position (operator)Wrong position (operator)• Poor communication Poor communication • Poor supervisionPoor supervision


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LTI:4 Ruptured spleen LTI:4 Ruptured spleen 6-Feb6-FebWhat happened?:What happened?:A food delivery truck travelling to Marmul. The driver fellA food delivery truck travelling to Marmul. The driver fellasleep. The truck left the road, rolled and crashed. Theasleep. The truck left the road, rolled and crashed. Thedriver was stuck for 2 hrs in the badly crushed cabin.driver was stuck for 2 hrs in the badly crushed cabin.

Result:Result:• Ruptured spleenRuptured spleen

(can be fatal)(can be fatal)• 2 months lost work2 months lost work• Lost truck & loadLost truck & load

Learning:Learning:• Journey Plan not followedJourney Plan not followed• Driver not authorisedDriver not authorised• Poor Safety attitudePoor Safety attitude


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LTI 5: Broken Leg LTI 5: Broken Leg 23-Feb23-FebWhat happened?:What happened?:Rigger climbed on the cabin to release the lifting slings. Rigger climbed on the cabin to release the lifting slings. He did not use a ladder. When coming down his footHe did not use a ladder. When coming down his footslipped and he fell.slipped and he fell.

Result:Result:• Broken legBroken leg• 6 weeks lost work6 weeks lost work

Learning:Learning:• Hazard not identifiedHazard not identified• Not using the right toolsNot using the right tools• Poor supervisionPoor supervision


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LTI 6: Back injuryLTI 6: Back injury 9-Mar9-Mar

What happened?:What happened?:Helper came out of the truck looking forward instead ofHelper came out of the truck looking forward instead ofbackward. He lost his his footing on the first step of thebackward. He lost his his footing on the first step of theladder and fell down hitting his back. ladder and fell down hitting his back.

Result:Result:• Back injuryBack injury• 2 weeks lost work2 weeks lost work

Learning:Learning:• Rule not followedRule not followed• Wrong way of Wrong way of

disembarking a truckdisembarking a truck


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LTI 7LTI 7&&8: Neck injury 8: Neck injury && 13-Mar13-Mar broken armbroken arm

What happened?:What happened?:Canter truck delivering most-urgent chemicals: nightCanter truck delivering most-urgent chemicals: nightdriving, very bad road due to rain, long driving hours. Thedriving, very bad road due to rain, long driving hours. Thetruck rolled over after hitting a bad spot on the road.truck rolled over after hitting a bad spot on the road.

Result:Result:• Driver: neck injuryDriver: neck injury• Helper: broken armHelper: broken arm• 22&&6 weeks lost work6 weeks lost work

Learning:Learning:• Poor planning/JMPoor planning/JM• 2 drivers on difficult trips 2 drivers on difficult trips • Contact TLM for urgent Contact TLM for urgent

deliveriesdeliveries


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LTI 9: Broken fingerLTI 9: Broken finger 25-Mar25-Mar

What happened?:What happened?:Thread protector stuck on a drill-pipe joint. Rigger takesThread protector stuck on a drill-pipe joint. Rigger takeshammer to free it. After two blows his colleague placedhammer to free it. After two blows his colleague placedhis hand on the protector to remove it just as the the thirdhis hand on the protector to remove it just as the the thirdhammer blow was given.hammer blow was given.


Learning:Learning:• Wrong tools.Wrong tools.• Poor communication.Poor communication.• Hazard not identifiedHazard not identified


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LTI 10: RTA FatalityLTI 10: RTA Fatality 3-Apr3-Apr

What happened?:What happened?:Truck delivering line pipe to Fahud. Driver probably fell Truck delivering line pipe to Fahud. Driver probably fell asleep. Went straight of off the road, rolled-over and asleep. Went straight of off the road, rolled-over and jack-knifed. Cabin completely crushed. jack-knifed. Cabin completely crushed.

Result:Result:• Driver deadDriver dead• Family lost their fatherFamily lost their father• Lost truckLost truck

Learning:Learning:• JM plan NOT followedJM plan NOT followed• STOP when tiredSTOP when tired


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LTI 11: Lost Finger LTI 11: Lost Finger 5-Apr5-AprWhat happened?:What happened?:A helper was disconnecting a trailer from an oil-field truckA helper was disconnecting a trailer from an oil-field truckwinch cable. He signaled the driver to slacken-off thewinch cable. He signaled the driver to slacken-off thewinch. Winch operator misunderstood and pulled-inwinch. Winch operator misunderstood and pulled-ininstead.instead.

Result:Result:• 2 lost fingers2 lost fingers• 4 weeks lost work4 weeks lost work

Learning:Learning:• Wrong hand placementWrong hand placement• Poor communicationPoor communication


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LTI 12: Elbow Dislocation LTI 12: Elbow Dislocation 7-Apr7-Apr

What happened?:What happened?:Crane operator drove too close to the edge of anCrane operator drove too close to the edge of anexcavation. Crane crashed down into the 3 m deep pit.excavation. Crane crashed down into the 3 m deep pit.Operator did have his seatbelt on.Operator did have his seatbelt on.

Result:Result:• Dislocated elbowDislocated elbow• 4-6 weeks lost work4-6 weeks lost work• Major crane damageMajor crane damage

Learning:Learning:• Hazards not identifiedHazards not identified• In a hurryIn a hurry


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LTI 13: Crushed FingerLTI 13: Crushed Finger 20-Apr20-Apr

What happened?:What happened?:A staff member was adjusting her shoe strap whilst walking.A staff member was adjusting her shoe strap whilst walking.She lost her balance and caught herself by placing her She lost her balance and caught herself by placing her hand against the doorframe. Her finger got trapped by thehand against the doorframe. Her finger got trapped by thespring loaded closing door.spring loaded closing door.

Result:Result:• Crushed fingerCrushed finger• 2 weeks lost work2 weeks lost work

Learning:Learning:• Do not try 2 activitiesDo not try 2 activities

at the same timeat the same time


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LTI 14: Broken FingerLTI 14: Broken Finger 28-Apr28-AprWhat happened?:What happened?:A floorman was instructed to use the rig tong to break a pipeA floorman was instructed to use the rig tong to break a pipeconnection. Instead, a colleague brought a big hammer andconnection. Instead, a colleague brought a big hammer andstarted to hit at the assembly. The hammer slipped and fellstarted to hit at the assembly. The hammer slipped and felldown onto the floorman’s hand.down onto the floorman’s hand.


Learning:Learning:• Not following instructions.Not following instructions.• Using wrong tools.Using wrong tools.• Wrong position.Wrong position.• Rush to finish the task.Rush to finish the task.


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LTI 15: Broken HipLTI 15: Broken Hip 29-Apr29-Apr

What happened?:What happened?:A technician placed a ladder against a storage rack andA technician placed a ladder against a storage rack andclimbed up to look for a flange. When coming down theclimbed up to look for a flange. When coming down theladder slipped and collapsed. He jumped off but knockedladder slipped and collapsed. He jumped off but knockedover a heavy crossover flange which in turn landed on hisover a heavy crossover flange which in turn landed on hiship.hip.

Result:Result:• Broken hipBroken hip• 3 weeks lost work3 weeks lost work

Learning:Learning:• Hazard not identifiedHazard not identified• Procedures not followedProcedures not followed• Never go up un-securedNever go up un-secured laddersladdersCould this be avoided?Could this be avoided?

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LTI 16: Broken Arm LTI 16: Broken Arm 2-May2-May

What happened?:What happened?:A technician was drilling a steel bar using a pedestalA technician was drilling a steel bar using a pedestalworkshop drill. The bar was clamped but slipped out of theworkshop drill. The bar was clamped but slipped out of thejig. He tried to grab the steel bar with his hands. His glovejig. He tried to grab the steel bar with his hands. His glovecaught in the drill and hands and arm were pulled into it.caught in the drill and hands and arm were pulled into it.

Result:Result:• Broken arm/open fractureBroken arm/open fracture• 2 months lost work2 months lost work

Learning:Learning:• Inadequate supervisionInadequate supervision• No list of authorised No list of authorised

equipment usersequipment users


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LTI 17: Finger Amputation LTI 17: Finger Amputation 19-May19-May

What happened?:What happened?: Riggers were assembling a downhole tool. One of them Riggers were assembling a downhole tool. One of them

attempted to support the upper section of the tool while attempted to support the upper section of the tool while both parties tried to mate the pieces together. The two both parties tried to mate the pieces together. The two sections came together with sudden force, catching the sections came together with sudden force, catching the index finger between the two parts and amputated the tip index finger between the two parts and amputated the tip of the finger completely. of the finger completely.

Result:Result:• Finger amputationFinger amputation• Several weeks lost workSeveral weeks lost work

Learning:Learning:• Hazards not identifiedHazards not identified• Wrong hand positionWrong hand position


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LTI 18: RTA Fatality LTI 18: RTA Fatality 24-May24-May

What happened?:What happened?: While transporting a 25 ton mobile crane from Yibal to While transporting a 25 ton mobile crane from Yibal to

Ghala on a flat bed trailer, the driver braked hard to avoid Ghala on a flat bed trailer, the driver braked hard to avoid a pot-hole in the road. The restraining system a pot-hole in the road. The restraining system (chains/shackles) failedThe crane moved forward into the (chains/shackles) failedThe crane moved forward into the back of the driver's cabin partially crushing it . The truck back of the driver's cabin partially crushing it . The truck driver died on the spot. driver died on the spot.

Result:Result:• Fatal InjuriesFatal Injuries(DEATH)(DEATH)

Learning:Learning:• Wrong trailer type used.Wrong trailer type used.• Wrong securing of the loadWrong securing of the load• Hazards Not identifiedHazards Not identified


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LTI 19: Broken Arm LTI 19: Broken Arm 28-May28-May

What happened?:What happened?: water-well diesel tank was being refilled from a road-water-well diesel tank was being refilled from a road-

tanker. The helper was sitting on top of the tank (1.4 m tanker. The helper was sitting on top of the tank (1.4 m high) holding the transfer hose. He lost his balance, fell high) holding the transfer hose. He lost his balance, fell down and broke his arm. down and broke his arm.

Result:Result:• Broken armBroken arm• Several weeks lost workSeveral weeks lost work

Learning:Learning:• Inadequate supervisionInadequate supervision• Wrong position.Wrong position.• Hazards not identifiedHazards not identified


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LTI 20: Broken Nose LTI 20: Broken Nose 25-May25-May

What happened?:What happened?:An engineer was disassembling a downhole logging tool An engineer was disassembling a downhole logging tool with a large spanner. He was pulling the tool towards with a large spanner. He was pulling the tool towards himself when it slipped. The top of the spanner hit his himself when it slipped. The top of the spanner hit his face resulting in a broken nose (displaced fracture). face resulting in a broken nose (displaced fracture).

Result:Result:• Broken noseBroken nose• Several weeks lost workSeveral weeks lost work

Learning:Learning:• Hazards Not identifiedHazards Not identified• Rush to finish the task.Rush to finish the task. • Wrong position.Wrong position.


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LTI 21: Eye Injury LTI 21: Eye Injury 29-May29-May

What happened?:What happened?: A driver decided to clean the cab of his truck. He took a A driver decided to clean the cab of his truck. He took a

compressed air-hose and started blowing away the dirt. compressed air-hose and started blowing away the dirt. The air hose kicked up and the steel tip hit his The air hose kicked up and the steel tip hit his unprotected eye. unprotected eye.

Result:Result:• Eye injuryEye injury

Learning:Learning:• Bad behaviourBad behaviour• Hazard not identifiedHazard not identified• Using wrong toolUsing wrong tool


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LTI 22: Broken FingerLTI 22: Broken Finger 1-Jun1-Jun

What happened?:What happened?: Two riggers were disconnected a 2” chicksan assembly. Two riggers were disconnected a 2” chicksan assembly.

When it was disconnected, the chicksan was pushed When it was disconnected, the chicksan was pushed vertically to be dropped in the opposite direction. Instead vertically to be dropped in the opposite direction. Instead it swung sideways and fell on the finger of one of the it swung sideways and fell on the finger of one of the riggers.riggers.

Result:Result:• deep cut and broken finger.deep cut and broken finger.• several weeksseveral weeks lost work lost work



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LTI 23: Broken Finger LTI 23: Broken Finger 19-Jun19-Jun

What happened?:What happened?: The floorman was setting drill pipe slips. One of the slip The floorman was setting drill pipe slips. One of the slip

segments caught in the lifting point of the master segments caught in the lifting point of the master bushing. The slips tilted forward trapped his finger bushing. The slips tilted forward trapped his finger between the slip handle and the elevator which was still between the slip handle and the elevator which was still moving downwards. moving downwards.

Result:Result:• Broken fingerBroken finger• Three weeks lost workThree weeks lost work



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LTI 24: Broken Finger LTI 24: Broken Finger 21-Jun21-Jun

What happened?:What happened?: A heavy duty driver was attempting to release a trailer

securing chains by hitting the boomer (load binder) with a cheater bar. He missed the boomer and struck his hand.

Result:Result:• Open wound & Open wound & • fracture fingerfracture finger• Several weeks lost workSeveral weeks lost work

Learning:Learning:• Inadequate supervisionInadequate supervision• Wrong hand placementWrong hand placement


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LTI 25: Broken Arm LTI 25: Broken Arm 22-Jun22-Jun

What happened?:What happened?: While tightening the centrilizer on bottom of ESP using a While tightening the centrilizer on bottom of ESP using a

wrench, mechanic with Wood Group ESP, placed both wrench, mechanic with Wood Group ESP, placed both feet on the wrench handle and used a second operator feet on the wrench handle and used a second operator as support. He lost control and fell to the ground. as support. He lost control and fell to the ground.

Result:Result:• Fracture of the forearm.Fracture of the forearm.• Several weeks lost workSeveral weeks lost work

Learning:Learning:• Bad behaviourBad behaviour• Wrong use of toolsWrong use of tools• Hazards not identifiedHazards not identified


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LTI 26: Crushed Finger LTI 26: Crushed Finger 29-Jun29-Jun

What happened?:What happened?: While pulling the 6" flow line pipe with a side boom, a While pulling the 6" flow line pipe with a side boom, a technician had to guide the pipe manually due to lack of technician had to guide the pipe manually due to lack of access on the pipe rack. His right hand's little finger access on the pipe rack. His right hand's little finger was crushed in between the pipe and guide angle. was crushed in between the pipe and guide angle.

Result:Result:• Crushed fingerCrushed finger• 3 weeks lost work3 weeks lost work



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Some questions for discussion in your teams:Some questions for discussion in your teams:

• Could any of these accidents have happened Could any of these accidents have happened in your team?in your team?

• What have you learned from these 26 LTI’s ?What have you learned from these 26 LTI’s ?

• Are you going to do things differently ?Are you going to do things differently ?

• Do you HAVE a Toolbox talks/meeting before Do you HAVE a Toolbox talks/meeting before you start a new job/task? Why?you start a new job/task? Why?

A free tip:A free tip: Find Hazards Find Hazards BEFORE BEFORE

They find YOU!! They find YOU!!

2002 26 lti’s in 6 months what are we going to learn? what should we do differently?

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