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Gulf Petrochemicals & Chemicals Association
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GPCA Contractors’ Learning From Incidents Portal
Company
Company Name
*
Email address
*
Focal Point Name
*
Contact Number
*
General Incident Information
Incident Title
*
Provide incident title (i.e. Chemical Splash, Gas release). Please write type of gas or chemical name while writing title
Incident Date & Time
Date
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Day
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Time of incident (Hours)
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Incident Details
Incident Description (What Happened?)
*
Provide brief and clear description of incident
Mode of operation
*
Normal
Planned Shutdown
Routine Maintenance
Startup
Upset
Turnaround
Emergency Shutdown
Transition
Others. Please Specify
Select mode operation at the time of incident occurred
Incident Consequences
*
Safety/Human Health
Fire or Explosion
Material Release (outside of secondary containment)
Community Impact
Off-Site Environmental Impact
Select Incident consequence. If more than one consequence, Tick mark on more than one consequence
Incident Root Causes Attributions (Why It Happened?)
Incident Root Causes (Why It Happened?)
*
2
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Additional Root Causes
Key Learnings
*
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Additional Learnings
Write key learning for each Root cause and contributing factors in the provided space
Upload
Attach relevant photograph (5 MB limit)