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TARONG ENERGY CORPORATION LIMITED

Generating

ICAM Analysis Form

Safety

Together

This form is to be used in conjunction with and attached to forms T-1307 Injury/ Illness Report Form and T-1039 HSE Incident Report Form. This form is to be used where an ICAM analysis is required for the incident (e.g. Potential Risk of Moderate) where full investigation and analysis is not required (Full investigation is required for Actual Risk of Moderate or higher / Potential Risk of High or Extreme using form T-1081 HSE Investigation Report). Use ICAM Pocket Investigation Guide to complete the analysis.

Incident Title:

Date:

People

Items to Consider: Records, Roster, History, Psychology; Physiology, Ability, Supervision, Alertness, Communication, Teamwork.

Environment

Data Collection / PEEPO Chart Equipment

Items to Consider: Design, Construction, Testing, Inspection, Maintenance, Modification.

Procedures

Organisation

Items to consider: Organisational culture, training program, visible support, Operational feedback processes.

Items to Consider: Illumination, Precipitation, Contaminants, Noise, Temperature/ Humidity, Wind/ Turbulence, Vibration, Acceleration or deceleration, Radiation, Work Surface/ space, Electricity, Air pressure, Wildlife.

Items to Consider: Utilisation, Content, Criteria, Validated, Control.

Document in Windows Internet Explorer All Incidents can be prevented by effective planning and implementation of our activities

Form No. T-1351 (07/07)

TARONG ENERGY CORPORATION LIMITED

Generating

ICAM Analysis Form

Organisational Factors Task / Environmental Conditions Individual /Team Actions Absent or Failed Defences

Safety

Together

Incident

Document in Windows Internet Explorer All Incidents can be prevented by effective planning and implementation of our activities

Form No. T-1351 (07/07)

Information

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