INCIDENT REPORT

IR-CBCI-C No.: 0001

Date of Incident: 8-Dec-19 Time of Incident: 7am-8:30am
Type of Incident: Water Tank Shortage (tank 2)

Equipment ID Equipment Manufacturer Supplier/Contractor

Installation Date: Recent Service Date:

Location of Incident: Incident Reported by: Raul Basas Jr. Facility engr
Equipment Operator Name: Signature:

Incident Description Person Injured?

Water tank 2 water shortage , due to motor pump breaker trip off, also some
other factors/contributors to be considered during the that time. The events do
Yes NO
flushing, water transfer at OTD 1 tank and before 6am there was a refilling of pool
at Amadera where the refilling of pool happened quite often, this factor causes Invironmental Effect?
the low water level at the tank. So by this, we would like to suggest that there
must be an indicator for water level and also to check the piping system of the
pool for maybe there is a leak. Yes NO

Equipment Effect?

Yes NO
Description, if any injury/Environmental/Equipment Effect:

Root cause of Incident:

motor pump breaker trip off

Correction Actions: Corrective Actions: Preventive Actions:

reset motor control and turn on breaker

To provide water level indicator
Operator statement: Witness Name & Statement:
DO sir Andrew
Facility engr: Raul
ORDC maintenance: Nestor
CGSI Maintenance: ArneL and Michael
Noted by:
Safety Office Signature: ORDC Duty Officer:

CBCI Prop. Manager: ORDC Property Manager: