Incident Report

Incident No.

18

Preliminary Report

Outline of Incident

Employee No.

Select Employee 004 - YUSHAV LUKHNA 022 - DYLAN PILLAY 041 - WADE NIEKERK 043 - RANESH BISNATH 1 - REUBEN MOODLEY 101 - FAIZAL KHAN 120 - N Mazibuko 13 - JETHRO GOVENDER 140 - JOAN JANSEN 157 - BLONDIE KLEIN 166 - SANDRA GORDON 167 - MORGAN VAN DER BYL 168 - MOSES CHETTY 177 - BASIL PILLAY 180 - ZELDA VERE 19 - KASVAN NAIDOO 2 - CARMANTHEA DOS SANTOS 201 - IGNUS MARAIS 203 - JULIAN PILLAY 204 - BHAVNA NARENSAMY 205 - Brandon Jones 206 - Thobile Vilakazi 207 - LINDO THOBELA 208 - Hamendra Hariprasad 209 - Lee-ann Tayob 210 - JIVESHEN MANICKUM 211 - S H MNCWABE 213 - RICOSH BHARATH 214 - LUNGI SHANGE 27 - Maanda Munyai 3 - KHALIK EUSUPH 4 - Z MADONDA 401 - KEVIN PILLAY 405 - CONRAD ZONDI 422 - PROTAS ZONDI 431 - A L DUMA 435 - WYNETTE NGCOBO 45 - SOOBREY GOVENDER 5 - KEVIN HARRY 500 - DEES PATHER 501 - RAVEN REDDY 502 - N P NXUMALO 508 - YVONNE MZOLO 599 - NATHI DLAMINI 600 - Gary Royston 602 - BRIAN NGCOYA 606 - TAMMY MCHUNU 61 - Mizpah Visser 659 - BONGANI MTHALANI 665 - KERSHNI NAIDOO 667 - MARK FISHER 67 - Roland Padayachee 671 - BUSIE MBATA 755 - SIPHO MVELASE 770 - WESLEY RAJAH 771 - KEITH NAIDOO 775 - FRANCE HLELA 780 - SIFISO NENE 782 - NKONZO MADONDO 783 - R C RUITERS 784 - DONOVAN BROWN 785 - HAKEEM FRANCIS 786 - M L JASSON 791 - SIFISO HUDLA 794 - JULIAN ZACCURI 795 - SANDILE THABEDE 799 - S NUNKOO 8 - ELAINE STAFFORD 826 - ASHTIQUE MANIRAM 830 - DF RENTON 835 - DAVID STIEGER 844 - THOBILE MTSHALI 847 - BLAKE EVERTON 849 - ELTON WESLEY 850 - JC JANSEN 851 - SPAMANDLA MLOTSHWA 853 - R C WHITE 856 - TYRELL LYONS 859 - WLT SHAW 863 - N REDDY 866 - SENZO KHUMALO 870 - ADRIAN DOS SANTOS 875 - O HARRY 879 - BEVERLY SIMES 886 - K JAMALOODEEN 890 - PRISCILLA SESELEE 891 - C BOOYSEN 892 - N ZUMA 894 - B MARAIS 895 - R N CAMP 896 - MUSI MADLALA 897 - D C NGUBANE 898 - SIMISELELO MKHIZE 900 - MARK NAIDOO 901 - T N MBAMBO 902 - MY HEMMERO 903 - SNE BUTELEZI 904 - P C MAVIMBELA 905 - SANDILE DLAMINI 911 - SIFISO SIBIYA 912 - SPHELELE PHUNGULA 913 - BONGANI MAFISA 918 - SIMPIWE SHANGE 923 - QUINTON ISAACS 925 - PRECIOUS ZUNGU 926 - GUGU NDLOVU 927 - ELIAS MNTUNGWA 928 - SANELE MNCULWANE 931 - BRIAN MADONSELA 935 - KEVIN PILLAY 936 - THEMBELANI ZUMA 937 - CYRIL MSOMI 938 - PRESTON GOVENDER 939 - MELU DLAMINI 940 - Arnusha Sukram 946 - DUDU NGUBANE 947 - LUYANDA NYEMBE 948 - BANDILE DLAMINI 950 - PATRICK KHUMALO 951 - SIBUSISO SOSIBO 955 - V Sukram 956 - XD Mchunu 957 - Ebrahim Mahomed 958 - YESHEN DEOLALL 959 - SIPHAMANDLA SIKOSANA 960 - THULA ZONDI 962 - Innocent Mbuyisa 963 - B K GOBA 964 - B R DONNELY 965 - S S NDAWONDE 966 - Vusumuzi Mpulo 966 A - Vusumuzi Mpulo 968 - Brandon John PETERS 969 - BLESSED JALI 970 - CHRISTINA JOSEPH 971 - NOSIPHO NDLOVU 972 - PRIANCA MAHARAJ 973 - SANELE BRAVEMAN MKHIZE 974 - JORDACHE PAUL 975 - MHLENGI DLAMINI 976 - N I MAZIBUKO 977 - T NKAQA 978 - S SITHOLE 979 - N M MBONGWA 981 - M I MKHIZE 982 - SALVATORIES N ZUMA 983 - ASANDA P MPUNGOSE 986 - M J KHUMALO 987 - M SHANGE 988 - AMANDA NDLOVU 989 - THABO C DLAMINI 990 - S S BHENGU 995 - MALIZOLE TOLIBADI 996 - Nadeem Pillay 997 - T M WOOD 998 - S NDLOVU 999 - Robin Royston CONT001 - JOHAN MARAIS CONT002 - MONGEZI NDLELA CONT003 - Michael Gabuza CONT004 - Marco Coetsee CONT005 - Nigel Michaels S005 - VICKY ZONDI S042 - PHILLIP PILLAY T900 - NOMA MNCUBE WRC001 - Mangaliso Mnguni WRC002 - DYLAN PILLAY WRC004 - LUYANDA NGUBO

Date of Incident Date blank

Incident Details

Location

Time of Incident Time blank

Injury

STOP 6 INCIDENT

Yes No

Body Part

Category of STOP 6

A B C D E F Other Non STOP 6

Type of Incident

FATALITY MAJOR MINOR FIRST AID NEAR MISS OCCUPATIONAL DISEASE ENVIRONMENTAL INCIDENT

Injured Person Status

WEBROY EMPLOYEE CONTRACTOR(CONSTRUCTION) CONTRACTOR (OTHER) OTHER Required

To be completed if a non Webroy Employee

Age

Gender

Job Title

Length of Experience

Years

Months

Female Male

Length of Service

Years

Months

Sample Obtained for Substance ?

Yes No Required

Breathalyser Test Conducted ?

Yes No Required

Result of Substance Sample

Result of Breathalyser Test

Test 1          Test 2

Preliminary Report Compiled By:

Signature:

Date:

Verified By:

Signature:

Date:

Final Report

Photo / Sketch

Description of Incident / Sequence of Events

<p><img src="Images/WIS/18_Overview.png" alt="" /><img src="Images/18_Overview.png" alt="" width="393" height="393" /><img src="\images\18_Overview.png" alt="" /></p>

<p>From the CCTV video you can see Adrian is cleaning the mould.</p> <p>The safety gate is open. You can see Adrian move the mould backwards, he then places his hand in the mould to clean and you can see it move back in place, trapping his hand.</p> <p>Sifiso quickly hits the emergency stop. Workshop are quick to respond and move the mould back and clear his hand.</p>

Suspected Causes

<p>The mould should not close when in manual operation. Potentially the mould was in automotic, and remembers the run buttons had been pressed. His overall zip could have touched the door sensor triggering the machine to run. <strong>Dees to trial, recreating this scenario. Found not to be the case. See HS Commitee for final conclusion</strong></p> <p>Adrian presses the move button with his other hand. The video is unclear but this does not seem to be the case.</p>

Countermeasure

Responsible Person

Target Date

Completion Status

When cleaning the mould safety wooden blocks should be in place. In case the machine does move or the mould closes they will jam on the blocks and avoid injury. Work Instruction should be updated to reflect the above change. Train

Chris

01/03/2021

Final Report Complied By:

Signature:

Date:

To be verified by HR Administrator

Form Annexure 1 Completed ?

Yes No NA

Incident Reported to DOL?

Yes No NA

Form WCI 2 Submitted

Yes No NA

Remarks by Health & Safety Commitee

<p>The machine was on a start mode, at the bottom screen is was showing auto. The only way the mould&nbsp; could move back is if it was changed to manual, this sends a signal to the machine to go back to a start position. Inconclusion with test conducted the only thing found was the change from "Auto to Manual" jamming into the mould. The machine must be removed "Auto" on the Arburg machine before switching the mahcine from Auto to Manual</p> <p><span style="color: #2dc26b;"><strong>Causes</strong></span></p> <p><span style="color: #2dc26b;"><strong>- Lack of training</strong></span></p> <p><span style="color: #2dc26b;"><strong>- Inadequate supervison</strong></span></p> <p><span style="color: #2dc26b;"><strong>- No SOP</strong></span></p> <p>&nbsp;</p>

Date reviewed by Health & Safety Committee :

Verified By Management

SHE Officer

Maintenance Manager

Production Manager

CEO