INCIDENT REPORT FORM

Use this form to report accidents, injuries, medical situations, criminal activities, traffic
incidents, or student behavior incidents. If possible, a report should be completed within
24 hours of the event.

Date of Report: January 21, 2023

PERSON INVOLVED

Full Name: RONNIE BAYLOSIS HAGORILES Address: Brgy Lawaan, Roxas City, Capiz

Identification: ☐ Driver’s License No. DO6-11-009385 ☐ Passport No. 31195855

☐ Other: _________________ Phone: 09123456789 E-Mail: ronniebh@gmail.com

THE
THE INCIDENT
INCIDENT

Date of Incident: January 21, 2023 Time: 01:30 ☐ AM ☐ PM

Location: Front of HERCOR College Main Campus, Brgy Lawaan, Roxas City, Capiz

Describe the Incident: That on or about 1:30 in the afternoon of this date, shooting incident
occurred in front of HERCOR College Main Campus, Brgy Lawaan, Roxas City, Capiz. Initial
investigation revealed that the victim was identified as Ronie Baylosis Hagoriles, 43 years old,
with live-in, balut vendor and a resident of Prk Kilometer 2, Brgy Lawaan, Roxas City, Capiz
who sustained gunshot wounds in different parts of his body that caused his instantaneous
death. Investigation further revealed that the victim had just arrived in his balut stall located at
front of HERCOR College Main Campus, Brgy Lawaan, Roxas City, Capiz to fetch his children
thereat. However, an unidentified male person pretended buying balut at the balut stall of the
victim suddenly shoot the unsuspecting victim hitting the latter on different parts of his body.
Thereafter, unidentified suspect run towards the direction of Prk Kilometer 2, Brgy Lawaan,
Roxas City, Capiz. Provincial SOCO team led by PCI Armando S Galigo Jr. also responded at
the crime scene to conduct their technical investigation at the crime scene. Two (2) fired shell
and one (1) fire slug of unknown type of caliber were recovered by the SOCO team at the crime
scene. Motive of the said incident is allegedly his previous involvement in illegal drugs activity.

INJURIES
Was anyone injured? ☐ Yes ☐ No

If yes, describe the injuries: gunshot wounds in different parts of his body, 1 shot to the upper
right shoulder, 1 shot to the upper left shoulder, and 1 shot to the left waist that caused his
instantaneous death.
 WITNESS
Were there witnesses to the incident? ☐ Yes ☐ No

If yes, enter the witnesses’ names and contact info: Richel Catalan Bermudez,
(09876543210/097536274) and Gado Madrigal (0987425167)

POLICE/MEDICAL SERVICES
Police Notified? ☐ Yes ☐ No If yes, was a report filed? ☐ Yes ☐ No

Was medical treatment provided? ☐ Yes ☐ No ☐ Refused

If yes, where was medical treatment provided? ☐ On site ☐ Hospital ☐ Other: _______

PERSON FILING REPORT

Signature: ________________________ Date: January 22, 2023

Print Name: ________________________

OFFICE USE ONLY

Report received by: PEMS GIEAH MARI ZUFIA BITO-ON Date: January 22, 2023

Follow-up action taken: Case held under investigation and follow-up. Progress Report to
Follow.
 DESCRIPTION OF INCIDENT

Location: Front of HERCOR College Main Campus, Brgy Lawaan, Roxas City, Capiz
Incident Details
Date: January 21, 2023
That on or about 1:30 in the afternoon of this date, shooting
incident occurred in front of HERCOR College Main Campus, Brgy
Time: 1:30 in the afternoon Lawaan, Roxas City, Capiz. Initial investigation revealed that the
victim was identified as Ronie Baylosis Hagoriles, 43 years old, with
Police Notified: live-in, balut vendor and a resident of Prk Kilometer 2, Brgy
Yes Lawaan, Roxas City, Capiz who sustained gunshot wounds in
different parts of his body that caused his instantaneous death.
No Investigation further revealed that the victim had just arrived in his
balut stall located at front of HERCOR College Main Campus, Brgy
Lawaan, Roxas City, Capiz to fetch his children thereat. However,
an unidentified male person pretended buying balut at the balut stall
of the victim suddenly shoot the unsuspecting victim hitting the
latter on different parts of his body. Thereafter, unidentified suspect
run towards the direction of Prk Kilometer 2, Brgy Lawaan, Roxas
City, Capiz. Provincial SOCO team led by PCI Armando S Galigo
Jr. also responded at the crime scene to conduct their technical
investigation at the crime scene. Two (2) fired shell and one (1) fire
slug of unknown type of caliber were recovered by the SOCO team
at the crime scene. Motive of the said incident is allegedly his
previous involvement in illegal drugs activity.

Incident Causes: Follow Up Recommendation:

Motive of the said incident is allegedly his
previous involvement in illegal drugs activity.
A case of FRUSTRATED MURDER is now being
readied against the apprehended suspect
(HAGORILES) for filing thru inquest proceeding at
the City Prosecutor office, Hall of Justice, Roxas
City.

Incident reports are necessary for documenting

details of the occurrence while they are most present REPORTED BY:
in the minds of the witnesses and incident reporter.
The information that is included in the report can be Name: PEMS GIEAH MARI ZUFIA BITO-ON
useful for decision-making on future incidents,
identify behavioral patterns and identifying larger Position: Police Executive Master Sergeant
issues. To maintain a safe and healthy work
environment, a thorough investigation should be Department: Roxas City Police Station
undertaken following an incident on order to initiate
corrective actions.