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Category Safety Business Unit HIPSI Report Date April 25, 2023

Report Preparer Arnel S. Pelaez Designation Corporate Safety Officer

(Name & Signature)

Report Approver
Michelle Gay T. Pelaez Designation SHES Manager
(BU Lead Name & Signature)

Incident
Date of the
April 24, 2023 Time Classification LTI Severit 4
Incident
y
Location of the Incident
Members of the Investigation Team (Name & Designation)
Pelaez, Arnel S. - Corporate Safety Officer Danilo G. Estimada – ESS Manager
Col. Paterno B. Calera - Corporate Security Officer Ruel B. Opsar – ESS Lead
Rex Vyron L. Apilado - Corporate Health Nurse
Description of the Incident (Impact of the Incident)
On April 24, 2023 at about 1625H, Mr. Bernacer, HIPSI Unit Lead driving the Grey Montero Sport with plate number LAA-6068 on the road
going out from the Port Facility. In about 100 meters away from the highway, Mr. Bernacer lost his control and tumbled down the said
vehicle to the right side of the road sustaining major damages. As per Mr. Bernacer, his driving speed at the moment before the incident
occurred are ranging from 60-80 kph. He also admitted that he was a bit drunk while driving the vehicle.

The subject sustained a minor abrasion on his right arm above the elbow. He was already advised by the Company Nurse to proceed to the
nearest hospital for a check-up. The subject reportedly collapsed during the rescue but is now conscious.
Photo Showing How the Incident Happened

Chronological Order of the Incident (How the Incident Happened)

At 1400H, Mr. Bernacer arrived from lunch break at the port facility and gathered his subordinates for a meeting. The subject
asked Mr. Angelo Rada, another personnel employed by the company; to buy a one (1) bottle of Alcoholic Drink
(Emperador). The subject and his team conducted the meeting with some rounds of shots of the drink that was recently
bought.
Before the
Incident
The meeting consist of the ff. personnel namely; Lindsey A. Bernacer, Marvin Leybag, Angelo Rada, Marvin Canete, Enrique
Reposar, Orael Infiesto, Leo Caluban.

The meeting adjourned minutes before Mr. Bernacer decided to head back home. His time out was recorded by the facility
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gate security on duty at exactly 1610H.

When Mr. Bernacer is heading out from the facility for home, at an estimated 90 meters distance from the highway, he
During the
suddenly lost his driving control and tumbled down the vehicle to the right side of the road sustaining major external damages
Incident
(Grey Montero Sport with plate no. LAA 6068). Mr. Bernacer sustained minor abrasion on his right elbow.

Mr. Leo Caluban, one of his personnel, pass by the incident scene and immediately helped the subject to come out of the
tumbled vehicle. He then called the assistance of the gate security personnel to call for help. Engineering Team (Ruel B.
Opsar and Danilo G. Estimada) and SCM Team (Alexis Urquico and Roel Mercurio) arrived at the incident scene. Mr. Danilo
Estimada, ESS Manager, called SHES Team to assist on the situation.
After the
Incident
SHES Team immediately assessed the incident and attended to the subject. Col. Paterno Calero immediately called the
(Including
assistance of Tagum City Police to conduct further investigation of the incident.
Mitigating
Actions)
The team conducted an initial investigation and elevated the incident details to the SHES Incident Notification Group.

SHES team then conducted thorough investigation of the incident to determine root cause/s and formulate
corrective/preventive recommendations.

Names, Designations and Roles of Involved Personnel

Lindsey A. Bernacer – HIPSI Unit Lead

CONTRIBUTORY FACTORS LEADING TO THE INCIDENT

Supervision and
Planning

Tools, Equipment, &

Materials

Environment and
The road was observed to be covered with loose gravels. Speeding on loose gravel roads can lead to accidents.
Weather Condition

Systems, Procedures
Drinking alcoholic beverages during working hours and on on-site duty.
and Instructions

1. Driving while under the influence of alcohol.

Human Factor
2. Speeding on a loose gravel road

ROOT CAUSE OF THE INCIDENT (Main Cause)

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CORRECTIVE / PREVENTIVE ACTIONS

Engineering Controls Estimated Cost Person Responsible Date of Implementation

Administrative Controls Estimated Cost Person Responsible Date of Implementation

Provision of warning sign “SLOWDOWN. LOOSE GRAVEL ROAD”
Provision of warning sign “SLOWDOWN. ACCIDENT PRONE AREA”

Personal Protective Equipment Estimated Cost Person Responsible Date of Implementation

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OTHER DETAILS
Accident Type (refer to DOLE
List)
The Agency Involved (The machinery or equipment involved in the accident) The Agency Part Involved (Specific part of the machinery or equipment involved in the
accident)
GREY MONTERO SPORT LAA-6068

The Unsafe Mechanical or Physical Condition The Unsafe Act

DRIVING UNDER THE INLFUENCE OF ALCOHOL

Mechanical Guards, PPE and Other Safeguards (at time of incident) Were all safeguards in use? If no, why?

Details of Damaged / Subject Property Corresponding Amount of Damage

GREY MONTERO SPORT LAA-6068. Recent preventive maintenance was conducted on October
2022.

Damages sustained due to the incident:

Major external damages, major dents and multiple scratches.

*Note: 1. Attach pictures and illustrations on a separate sheet, with proper captions and explanations.
2. Attach individual (per injured employee) Medical Case Management Report if Injury is involved

For SHES Unit Use Only

Received by: SHES Manager Entries
(Name, Signature & Date) Report Acceptance: Internal Report Escalation: External Report Escalation: Closed:

(Remarks, Name, Signature & Date) (Remarks, Name, Signature & Date) (Remarks, Name, Signature & Date) (Remarks, Name, Signature & Date)
DATE DISABILITY DATE RETURNED TO DAYS LOST DAYS CHARGED Verified by:
BEGAN WORK

*Note: Incident Closure Report should be attached

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ANNEX A. IMPACT ESTIMATES

COMPENSATION
DETAILS OF COMPENSATION COMPENSATION AMOUNT MEDICAL AND BURIAL
HOSPITALIZATION

MANPOWER
TIME LOST ON SUBSEQUENT TIME ON LIGHT WORK
TIME LOST ON DAY PERCENTAGE
DAYS OR REDUCED OUTPUT
OUTPUT
HOURS MINUTES HOURS MINUTES (days)

MACHINERY AND TOOLS

LOST COST OF
COST OF REPAIR PRODUCTION LOST
DAMAGE TO MACHINERY AND TOOLS (describe)
OR REPLACEMENT TIME PRODUCTION
(in hours) TIME

MATERIALS
LOST COST OF
COST OF REPAIR PRODUCTION LOST
DAMAGE TO MATERIALS (describe)
OR REPLACEMENT TIME PRODUCTION
(in hours) TIME

EQUIPMENT
LOST COST OF
COST OF REPAIR PRODUCTION LOST
DAMAGE TO EQUIPMENT(describe)
OR REPLACEMENT TIME PRODUCTION
(in hours) TIME

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