EEI CORPORATION

THE BEACON TOWER PROJECT

Construction Division R

Job # 7040

Date : May 19, 2009

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

PERSONAL CIRCUMSTANCES:

PERSON INVOLVED : EDWIN B. LOPIO (Rough Carpenter)

DATE/TIME OF ACCIDENT: May 16, 2009 / 5:00 P.M.
PLACE OF ACCIDENT : Ground Floor, billboard area
EXTENT OF INJURY : Hematoma on waist

DESCRIPTION OF ACCIDENT:
On May 16, 2009, at around 5:00 P.M. Mr. Edwin Lopio suffered hematoma on
his waist (right side).

RELATED FACTS:

1) At the given date and time, while Edwin Lopio was cutting a pipe
connections at the billboard located at the front side of the building
project, the said pipe slid which accidentally hit his body.
2) Mr. Domingo Fogata sustained hematoma tion on his right side lower
abdomen.

RECOMMENDATION:

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

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

For your information.

H.A. Adion
Safety Engineer