ACCIDENT / INCIDENT SUMMARY REPORT

PROJECT NAME: Valenzuela Rincon Project

For The Month of: Jul-19 Total Accidents Reported : 08 01

Item Name / Designation of Date and Time of Brief Description of Accident / Incident / Corrective / Preventive Action Status of Corrective / Days Estimate/ Actual
Person Involved Incident
Classification Remarks
No. Near miss Taken Preventive Action Taken Lost Repair Cost

Procurement of Bench Vise use to

While cutting angle bar for vault cover grip the angle bar while it is being included in Re-orientation 2,000.00 + for
1 NA July 01, 2019 precast Welder Mark Necio left leg was MTI cut. Advise MMD Dept to request program and being NA medical treatment and Closed
accidentally cut with a four (4") cutting disc additional 4" cutting discs with monitored regularly medicines
buffer stock

CLASSIFICATION :
LTI - Lost Time Incident MTI - Medical Treatment Injury FAI - First Aid Injury NM - Near Miss PD- Property Damage SWR - Security Work Related

Prepared by: Verified by: Noted by:

Marzelino Yee Inoferio Mark Anthony Dy Unay Brandon O. Saliot

Project Safety Supervisor Safety Manager Project Manager

LE-FM 06-36 Effectivity Date: March 14, 2014

Rev.0
ORT