permanent ABC workers and contractors. There has always been extensive use of contractors on Ingens and there are clear lines of communication between the contractors and the ABC workers. An Offshore Installation Manager (OIM) has overall responsibility for Ingens including health and safety, supported by shift managers. The OIM agrees the content of, and signs off, the health and safety policy. Findings from past incidents on some of ABC's other platforms have led to safety improvements on Ingens. This includes equipment, processes and procedures. Ingens has a reporting procedure in place for near misses and accidents. However, there have been no serious incidents reported in the last year, although there have been a few near misses. On arrival on Ingens, ABC workers receive induction training from shift managers which includes basic first-aid and manual handling training, site rules and emergency procedures (which are practised regularly). Site rules include the requirement for personal protective equipment (PPE) to be worn at all times, and to carry a two-way radio which will be issued after induction. Some contractors have complained that they may not receive inductions until several days after arriving on Ingens. During these contractor inductions, those responsible for health and safety are identified, such as the OIM and shift managers. The content of the health and safety policy is also communicated during all inductions. There are several first-aiders on Ingens spread across different shifts. There is also a well-equipped medical room (that has specialist lifesaving equipment) staffed by a trained paramedic. If, following an accident, medical evacuation is necessary, the procedure in place is to make the area safe, treat the injured, and the OIM calls the nearest ABC onshore control facility for a helicopter. On Ingens, most tasks operate under a permit-to-work system. The site rules say that no-one should be allowed to work without a permit-to-work (PTW), the specific requirements of which should be communicated prior to starting work. The OIM and shift managers have daily safety meetings, and information from these meetings is communicated to workers. The OIM also monitors health and safety, carrying out regular audits, and expects shift managers to perform regular safety inspections. The OIM is also expected to carry out annual health and safety performance reviews. Both the OIM and the shift managers are highly respected by workers and contractors. If workers have any health and safety concerns, they are comfortable talking to them as they know they will be heard. The OIM and the shift managers are often seen speaking to workers and contractors. During a dark, rainy day, after a violent storm the night before, two workers walked past staircase 10 exposed to the prevailing weather conditions. They noticed a light was damaged and hanging from its fitting above the staircase. They reported the issue to the day shift manager. Several hours passed, and it was almost the end of the shift before the day shift manager remembered to address this. They decided to leave a note for the night shift manager to send someone to look at the light. During the handover, the night shift manager read the message but decided not to deal with it straight away because they would have to produce a safe working procedure and a PTW. No other workers were warned about the poorly-lit staircase 10. IG1 IGC1-0018-ENG-OBE-QP-V1 Aug22 NEBOSH 2022 page 2 of 5 Two contractors (one of them a young worker) arrived on Ingens for the first time, to carry out some work near to the top of staircase 10. Although they had not received an induction, they were asked to start night-work immediately. The intention was to give them their full induction the following afternoon. In the meantime, they were given a written summary of the health and safety policy including site rules and reporting procedures. They were anxious to start work, so put the information in their pockets to read later while they hurried to find the location of the job. The two contractors decided to use staircase 10 to access the job location while carrying heavy tool boxes. They were talking about how tired they were due to the long journey to get to Ingens. Even so, the younger contractor was keen to start the job. As they started climbing staircase 10, the young contractor stepped onto the second step, which collapsed under them. As a result, they fell directly onto the platform below. Due to the poor visibility, the older contractor shouted down to the injured contractor who was unresponsive. The older contractor shouted for help in a very agitated state trying to get someone's attention. After a couple of minutes, another worker responded to the contractor and raised the alarm via their two-way radio. It took ten minutes for a first-aider to get to the casualty because they were on the far side of Ingens. Access to the injured contractor was further delayed due to the broken step. The first-aider found the worker unconscious and suspected serious internal injuries. Noting the seriousness of the injuries, the first-aider summoned the paramedic and alerted the OIM. The OIM arranged for a medical evacuation. The paramedic stabilised the injured person and moved them to the medical facility. The OIM saw that the older contractor was in shock and insisted that they were taken to the OIM's office. The OIM instructed the shift manager to cordon off the staircase area and tell the workers to leave the scene as it was. The OIM arranged for photographs to be taken of the area. The OIM returned to their office and asked if the older contractor was ready to discuss the accident. They asked if they could record the discussion so that it could be referred to when compiling the report. The OIM then had a similar discussion with the first-aider and the paramedic. The OIM noticed that the first-aider appeared to be traumatised as they were not saying much. Following these discussions, the OIM revisited the scene of the accident to survey the area again and found that the step that had failed appeared to have been severely corroded from beneath. Due to the secident, all work had to be stopped on lesene until the medical evacuation was corried. Due to the accident, all work had to be stopped on Ingens until the medical evacuation was carried out, some 2 hours after the accident. The young contractor spent 2 weeks in hospital and was off work for 6 months recovering from the injuries sustained in the fall. The first-aider also needed counselling and was off work for 2 weeks. Task 2: Management failures 2 Based on the scenario only, what management failures by ABC Oil Company contributed to this accident. (10)