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IINCIDENT T <br /> NOTIFICATION <br /> * <br /> Required Fields <br /> *Incident Date: *Incident time: *Location: <br /> *City State(Province): *Country <br /> *Client name: Employee type: <br /> Involved parties: If other involved parties,please specify: Project Manager <br /> Construction Manager Superintendent Foreman <br /> *Project type: *Project type subcategory: <br /> *Incident summary: <br /> * Incident detailed description: <br /> Immediate actions taken: Responsible Supervisor: <br /> Tier 1 <br /> Project HSSE Manager District HSSE Manager Area HSSE Manager <br /> Onsite Senior Operations Manager <br /> Tier II <br /> Corporate Manager HSSE Systems Global VP HSSE VP Project Services <br /> Country/District/Unit Operations Manager CBI Lummus Construction/Fabrication VP CBI Lummus/SPS Sector VP of Operations <br /> CBI SPS Area Operations VP <br /> Sector President Sector HSSE Director <br /> Tier III k; <br /> Chief Executive Officer Chief Operating Officer <br /> Additional People to Notify: <br /> INCIDENT I?ETAILS <br /> *Required Fields <br /> *Occupation: <br /> *All Consequences of the Incident: <br /> ❑ Environmental ❑ Equipment Damage or Loss ❑ Fire <br /> ❑ Residual Hazard/Effect ❑ Injury or Illness ❑ Motor Vehicle Accident <br /> ❑ Near Miss ❑ Security <br /> Initial Risk Assessment: <br /> Consequence: Probability: <br /> ❑ Insignificant ❑ Rare <br /> ❑ Minor ❑ Unlikely <br /> ❑ Moderate ❑ Possible <br /> ❑ Major ❑ Likely <br /> ❑ Catastrophic ❑ Almost Certain <br />