Gledco Multipurpose Cooperative

Brgy. 9 Sta. Angela, F.R. Castro cor Balintawak St., Laoag City 2900
Registration No. 9520-01001354 | TIN 005-511-934 | CMP # 4178
(077) 677-1880

EMPLOYEE INCIDENT REPORT

Reported by: MARCIUS KENNY B. RAQUINIO Date of Report: MARCH 16, 2022
Position: SITE SUPERVISOR Incident No.:___________________

EMPLOYEE INCIDENT INFORMATION:

Employee Name: JACKLEE MACABURAS Position: LEADMAN DSP 2
ELMER TAPAC DRIVER/HELPER DSP 2
RENZ JOCER MORALES HELPER DSP 2

Date of Incident: MARCH 16, 2022 Time of Incident: 2:31 PM

Location: BRGY. MAGNUANG
Specific Area of Location: BATAC CITY, ILOCOS NORTE
Additional Person(s) Involved:

Witnesses: SAMMY PAGTAMA (house owner)

Incident description including any events leading to or immediately following the incident:
FULL GOODS
Coke 1.5 – 1 case = 660.00
Sprite mismo – 2 cases = 290.00
Royal mismo – 1 case = 145.00
Coke litro - 6 case = 1,950.00
Coke 8oz – 1 case = 145.00
Coke 12oz – 1 case = 250.00
Total of 3,440.00 pesos
BREAKAGE OF MTS
Litro bottle – 72 bottles (*6) = 432.00
Plastic bottle – 48 bottles (*2) = 96.00
3,440.00 + 528.00
Total of 3,968.00 pesos

CEMENT FENCH
HALLOW BLOCKS – 50 PCS = 50(*12) = 600.00
CEMENT – 2 BAGS = 2 (*250) = 500.00

Glad ako sa GMC!!!

 Gledco Multipurpose Cooperative
Brgy. 9 Sta. Angela, F.R. Castro cor Balintawak St., Laoag City 2900
Registration No. 9520-01001354 | TIN 005-511-934 | CMP # 4178
(077) 677-1880

LABOR – 2 = 2(*550) = 1,100.00

TOTAL OF 2,200.00 pesos

TOTAL OF 6,168 PESOS

SS
Employee explanation of events / circumstances:

Ayon sa kwento ni Mr. Elmer Tapac driver ng truck (MAT 3288) habang nagdedeliver sa magkabilang
outlet nila sa brgy. Magnuang ay biglang bumulosok ang sasakyan nila pababa na tumama naman sa
bakud at mga halaman sa bahay ni Mr. Sammy Pagtama. At dahil sa slope area yong location nilagyan
ni Mr. Renz Jocer Morales ng bato sa likud ng tire bilang chocks or harang para sa katulong ng hand
break pero habang sila ay kumukuha ng stocks sa sasakyan ay hindi kinaya ng hand break at bato sa
bigat ng dala nilang full goods. Hinabol umano ni Mr. Elmer pero hindi na kaya sa bilis na pagbaba ng
sasakyan.

Resulting action executed, planned, or recommended.

ALREADY REPORTED TO GROUP SUPERVISOR CHERRY SANTOS AND CHIEF OPERATING
OFFICER HERACLEO PASCUAL.

Employee Employee Date: ____________

Name: JACKLEE MACABURAS Signature: _____________
ELMER TAPAC Signature:______________
RENZ JOCER MORALES Signature:______________

Reporting Reporting Staff Date: ___________

Staff Name: MARCIUS KENNY RAQUINIO Signature: ______________

HR Rep HR Rep Date: ____________

Name: ________________________ Signature: __________________

Glad ako sa GMC!!!