Republic of the Philippines

Department of Education
Region XI
DIVISION OF DAVAO DEL SUR
Kiblawan South District
EMILIO JOSE SR. ELEMENTARY SCHOOL

INCIDENT REPORT FORM

TYPE OF INCIDENT

Collapse of the Old Home Economic Building

INCLUSIVE DATE AND TIME OF INCIDENT

September 19, 2022 at 12:55 PM in the afternoon.

EXACT LOCATION OF INCIDENT: (room, building, area, school, sitio, barangay, municipality, etc.)

The incident happens inside the school campus of Emilio Jose Sr. Elementary School, Brgy. Dapok Kiblawan, Davao
del Sur
INVOLVED PERSONS & SPECIFIC PARTICIPATION: (Full name, age, gender, position/designation/grade level,
involvement in the incident. Use back page if needed)

Mrs. Vilma A. Parantar the school utility of Emilio Jose Sr. Elementary School, the learners of Grade V- Amethyst
and some of the parents witnessed the sudden collapsed of the building.

NARRATIVE DETAILS OF INCIDENT: (Describe how the incident happened, scene of incident, physical and emotional
state of involved persons, description of injuries/damages to properties, impact to class/school/community, etc. Use back page if needed.)

On September 19, 2022, at 12:55 p.m., a strong wind blew down the old tamarind tree located at the back of the
abandoned school building and unfortunately fell on the old and dilapidated Home Economic School Building, which
was built in 1975. The incident caused the building to completely collapse and obliterate, as well as damage to the
school internet tower due to the sudden collapse that struck the internet tower and prompted it to fall into the ground.
ACTION/S TAKEN: (Narrate responses/decisions implemented by school authorities, state name of official. Use back page if
needed.)

The incident was reported to the Division Office through Engr. Ariel D. Duco.

RECOMMENDATIONS: (State suggestions that higher DepEd officials/other government agencies must perform further to fully
respond to situation. Use back page if needed.)

Engr. Ariel D. Duco advised, that we send a demolition request to the Engineering Office of the
Municipality of Kiblawan and to the Division Physical Plant and Facilities Coordinator for even further
action.

REPORTED BY: (Full name, position/designation and signature) DATE RECEIVED: (to be accomplished by
SGOD staff)

LYNDON A. QUINES
School Head
REVIEWED BY: (Full name, position/designation and signature) RECEIVED BY: (to be accomplished by SGOD
staff)

ENGR. ARIEL D. DUCO

Engineer III