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INCIDENT/ACCIDENT REPORT

EXACT LOCATION: DATE: TIME: DATE REPORTED:


12-Jul-18 7/13/2018
FIRE EXIT DOOR
1. OBJECT/EQUIPMENT/INFLICTING INJURY 2. OBJECT/EQUIPMENT/SUBSTANCE/INFLICTING DAMAGE
UN SAFE ACT
(A- LADDER 6ft.)
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3. DESCRIPTION: DESCRIBE CLEARLY HOW THE INCIDENT OCCURRED.


WORKER CAUGHT IN THE ACT OF WORKING AT A- TYPE LADDER ON THE OPPOSITE SIDE, IT IS REPORTED THAT THE
INCIDENT OCCURRED WHILE THE TWO WORKERS( CHRISTIAN SANTOS & JING CARAYPAYAN) ARE ON THE AREA DOING
ELECTRICAL WORKS FOR THE EXIT DOORS, THE LATTER GAVE INSTRUCTION TO MR. JING TO HAND HIM SOME
MATERIALS NEEDED TO BE INSTALLED, THE PIC AT THE EMAIL DOES NOT INCLUDE MR. JING BUT HES IN THE VICINITY
TOGETHER WITH HIS BUDDY CHRISTIAN, THOU CHRISTIAN IS FACING THE OTHER SIDE HE HAS A COMPLETE CONTROL
OF HIS BALANCE AND HAD A ADEQUATE FIRM HOLD.

4. ANALYSIS
WORKER IS NOT PROPERLY INSTRUCTED

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(B) WHAT ARE THE BASIC OR FUNDAMENTAL REASONS FOR THE EXISTENCE OF THESE ACTS AND/OR CONDITIONS.
WORKER DID NOT WAIT FOR HIS BUDDY TO ARRIVE BEFORE RESUMING WORK.
INADEQUATE INSTRUCTIONS

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5. PREVENTION: WHAT ACTION HAS OR WILL BE TAKEN TO PREVENT RECURRENCE?NUMBER ALL ITEMS IN SEQUENCE.
1. ATTEND DAILY TOOLBOX MEETING
2. REFRESHER COARSE ON LADDER SAFETY/ IMPORTANCE OF BUDDY SYSTEMM
3. DEBRIEFING OF WORK INSTRUCTIONS, RESISTANCE OF UNSAFE ACTS.
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6. PREVENTION METHOD ENFORCED:

CONDUCT LADDER SAFETY TALK


7. INVESTIGATED BY: SIGNATURE: DATE:

JULIUS ERLANO
(PRINTED NAME)

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