EEI CORPORATION

THE BEACON TOWER PROJECT

Construction Division R

Job # 7040

Date : June 18, 2009

To : F.T. Dacquel, Jr.
From : SAFETY DEPARTMENT
Subject : ACCIDENT REPORT

PERSONAL CIRCUMSTANCES:

PERSON INVOLVED : CHARLIE C. FLORES (LH- Rough Carpenter)

DATE/TIME OF ACCIDENT: June 17, 2009 /5:20 P.M.
PLACE OF ACCIDENT : Area 2, level 42
EXTENT OF INJURY : Foreign body on left eye

DESCRIPTION OF ACCIDENT:
At the given date and time, while Charlie C. Flores was sorting out plywoods in
preparation for their table form works activity at level 42 of area 2, a fleck of sand
accidentally hit his right eye.

RECOMMENDATION:

1.) To be referred to St. Patrick Clinic for further examination.

2.) To be discussed in the next toolbox meeting.

For your information.

H.A. Adion
Safety Engineer