hsse综合管理制度-14hsse-pi汇报模板

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1、ReportingHotLine:85296339HSEDepartmentUseFileNo.:CaseNo.:ShellGuangzhouPetroleumCo.Ltd.(A)Time&LocationDate:2009-4-15Locations:广州市荔湾区芳村Time:13：00Others:(B)ReporterDetails(Optional):Name:李海锋Employedby:ShellGuangzhouPetroleumCo.,LtdIndicator:DSCF/312ContactTe

2、lNo.:13925039930PotentialIncidentReportForm*APotentialincidentisanyrelevant,foreseeableandcredibleundesiredhazardousscenariowithforeseeableandquantifiableconsequences,fromwhichHSElessonscanbeleiimed.(C)Description:2009年4刀15日到新会汇通油漆公司场地评估时，看见该司油缸为地血缸，但卸油无快速接

3、口，卸油时需人爬上去拉住油管才能进行。由于汕缸顶部及周围都无任何防护栏，一旦卸汕时人工操作不当，即有漏汕及人从缸顶掉下來的风险。Please□□□7□口N)RoadMarinePlantOutletsOffice(D)EstimatedSeverity:-Pleasetick(Pleaserefertoguidelinesonthebackpage)RatingPeople(P)Asset(A)Environment(E)1.Slight:Slightinjury:Olli:Slightdamage:iiii

4、:Slightleak；iiii2.U•Minorinjury•iiii■Minordamage•iiiiiiii■Minorleak/spill■iiii■Localiseddamage■VLnVHAcDEA7BcDEA7BcDE:Fatality/Totaldisable；MiyordamageMajorleak/spill5.SeriousMultiplefatalityExtensivedamageMassiveleak/spill)iiii(E)InformAreaController/LineSu

5、pervisor/LineManageron(dd/mm/yy)：(/Nameandindicatoroftheinformedparty:(F)InformtheReporterthatthecaseisbeinghandledon(dd/mm/yy):((ProvidedfhmtheReporterhasleavehis/herHtuneandcoMactteLno.)LilyChen84933666Indicator:DSCF/312Signature:Date:2009-4-15(G)CaseReco

6、rdedby:(H)RemedialAction(tobecompletedbyresponsibleAreaController/LineSupervisor/LineManager):RemedialActionActionByDateofCompletionLiHaifeng2009-4-18建议客户：1、增加进汕管线的快速接口；2、在油缸周围增加围栏。(J)Review/RecommendationbyHSEDepartment:(JI)EstimatedSeverity：・Pleasetick(Pl

7、easerefertoguidelinesonthebackpage)RatingPeople(P)Asset(A)Environment(E)1.SlightJSljghtinjury；JSlightdamage[；Slightleak；2・UiMinorinjuryi・■■■iMinordamagei■■■iMinorleak/spilli■■・■3・U:Majorinjury:1l-ocaliseddamage1:lx)cal.isedleak/spill:4・U:Fatality/Totaldisab

8、le:Majordamage::Majorleak/spill:5.Serious・■iMultiplefatalityiIfii■■iExtensivedamage•f1ivi■■■Massiveleak/spill>IlliVL=>VHA1B1C1D1EA1BC[D1EA1B

9、CD

10、EName:LiHaifeng(J2)Recommendations:Reviewedby:Date(dd/mm