INCIDENT/ACCIDENT INVESTIGATION REPORT

Employer : Metro Stonerich Corporation

Project : The Loop North Tower

( X ) Incident ( ) Accident ( ) Near Miss

Date of Occurrence : May 24, 2019

Location : 7th Floor, Unit 23

Subject : Fire Incident

How It Happened (short but concise narrative of what happened):

Please be informed regarding the incident occurred last May 24, 2019 Friday around 9:00
a.m. where Mr. Alvin Bucoy, a welder, was cutting dowel bars at 8h floor (unit 23). Fallen fluxes
were not anticipated due to unnoticeable small hole at the floor. A painter at 7th floor (unit 23)
coincidently left his working area, covering the vinyl tiles with sakoline laminated sack, while fluxes
passed through this hole which then resulted to damaged installed vinyl tiles at 7th floor (unit 23).

Action Taken : Conduct thorough investigation

: Called the attention of the safety officer of MGS
: Prepare written report

Recommendation : Use fire blanket for protection from welding flux.

Acknowledgement of the veracity of the above foregoing statements given out of their own free will and no coercion was involved.

Prepared by: Reviewed by:

Christine D. Abrenica Meljhon C. Blanco

Signature: Over Printed Name
Creamer L. Libor Company: Metro Stonerich Corp.
Signature: Over Printed Name Position:Safety Officer
Company: Metro Stonerich Corp.
Position: OJT

Noted by:

Engr. Ryan G. Lumba

Signature: Over Printed Name
Company:Metro Stonerich Corp.
Position: Project Manager
F-C&M-021
January 30, 2009
Rev.:0
F-C&M-021
January 30, 2009
Rev.:0