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Incident Notification Form

INCIDENT NOTIFICATION
Prepared by Christopher Jason Flores
Department/Section Warehouse
Date of Incident
10 February 09:00
(day / date / time)
Junior
Name of Employee  James Navidad Position of Employee:
Warehouseman
Incident Description Upon inspecting of forklift fire extinguisher #2 it was seen to be discharged
even if it not yet used.

Nature of Injury

Immediate Actions Replaced with unused fire extinguisher for forklift.

HSE-F-008 Revision Number: 0


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Incident Notification Form Effectivity Date: 02-01-2020

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