DOW RESTRICTED - For internal use only Incident Report 11/27/2018 DOW RESTRICTED - For internal use only

DOW RESTRICTED - For internal use only Incident Summary Project Incident Location Company Day / Date / Time Incident Classification Status Craft Name Employee Experience – Craft Employee Experience – Site Immediate Actions Taken Environmental Elements Weather Night Work 11/27/2018 DOW RESTRICTED - For internal use only

DOW RESTRICTED - For internal use only Incident Description Describe event – keep to one page 11/27/2018 DOW RESTRICTED - For internal use only

DOW RESTRICTED - for internal use only Drawings or Pictures 11/27/2018 DOW RESTRICTED - for internal use only

DOW RESTRICTED - for internal use only Summary Root Cause Corrective Action Contributing Factor 11/27/2018 DOW RESTRICTED - for internal use only

DOW RESTRICTED - for internal use only Swiss Cheese Model Strategy System Sharp End Accident Triggering events Active 6 11/27/2018 DOW RESTRICTED - for internal use only

DOW RESTRICTED - for internal use only Post Incident Update Incident Scene Status Key Observations Worker Behavior Equipment / Tool Utilization 11/27/2018 DOW RESTRICTED - for internal use only