Instructions On How To Properly Fill in The WAIR
Instructions On How To Properly Fill in The WAIR
Instructions On How To Properly Fill in The WAIR
The purpose of the WAIR is to allow the DOLE to determine root cause and allow investigation into possible solutions to
workplace accidents lowering the financial and time cost to both the worker and employer. Please fill in all fields as completely
as possible. Visitors / guests to the workplace shall be categorized under "worker" for the purpose of the WAIR.
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1 If yes, then report to DOLE Regional Office using the DOLE-BQF-ALERT Form manually or online. Have the filled-in form
ready for the labor inspector. Contents of form may be relayed over phone if this would facilitate the speed of communicating
the event to DOLE.
2 Put an X if with or without Dangerous Occurrence
3 Refer to Reference Coding List D1-D18
4 Indicate if DOLE was notified within 24 hours (as noted in Item #1)
5 Put an X on the action taken by the Safety Officer.
6 Put an X where accident happened. Leave blank if not in given choices. Indicate location in the narration of the accident
7 Trade name of the business if different than the registered business name
8 SEC or DTI registered address of establishment.
9 SEC or DTI registered business name that hired and pays the wage/s of the involved worker
10 Refer to Reference Coding List Philippine Standard Industrial Classification, 2009
11 SEC or DTI registered business Owner/President/CEO/Chair
12 List number legally male and female workers hired and paid wages by the business (9) regardless of nature of employment
13 Date accident happened in Year, month, and day (Ex. 2019 Jan 01)
14 Time accident happened in 12 hour format (Ex. 10:00 AM, 11:30 PM)
15 Refer to Reference Coding list C1 to C9.2
16 Put an X on the appropriate answer
17 Describe all safety hazards present. Attach additional sheets as necessary.
18 Put an X on the appropriate answer
19 Describe all health hazards present. Attach additional sheets as necessary.
20 Describe other aggravating factors that may have aggravated the accident not previously described.
21 List materials and equipment that are primarily involved in the accident
22 Indicate time of start and end of shift and mark an X if AM or PM
23 Narrative of events leading to the accident. Attach pictures of the accident if available.
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26 and 27 - Indicate if with machine damage and approximate total cost of the accident.
28 Indicate as DD/Month/YY (01 Jan 2018)
29 Indicate as HH:MM AM/PM (12:00 PM)
30 Refer to Reference Coding List C1-C16
31 Indicate the start time (HH:MM AM/PM) and end time (HH:MM AM/PM) of the worker's shift
32 Narrate events leading to the accident
33 Signature of the injured worker or employee's representative testifying that the narrative is correct.
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49 If with capability, images of the accident before and after placing of the corrective measures may be included in the report.
If the corrective measure is not in place by WAIR submission date, then corrective measure will be part of what will be
inspected by the labor inspector.
50 Name and signature of safety officer verifying that the corrective measures are physically in place. Write N/A if the
corrective measure is not in place by WAIR submission.
51 OH personnel or safety officer that conducted the investigation and filled in part of the report
52 Employer or representative that supplied part of the report
53 Date the Accident Investigation was done.
We hereby certify that the information above is accurate to the best of our knowledge. We understand that data
contained herein is compliant to RA 11469 Bayanihan to Heal as One Act and protected by RA 10173 Data
Privacy Act of 2012.
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DOLE-BQF-WAIR
Health Hazard (Choose all that apply): Physical Chemical Biological Ergonomic None
Describe selected Health Hazard/s:
Printed Name of Injured Worker or Representative Sign above your name if you agree to the events narrated
Immediate Action done for the injured worker/s:
Corrective Measures planned and expected date of implementation to prevent recurrence of accident
(You may use another sheet if more space is needed, attach pictures if available):
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DOLE-BQF-WAIR
Section III. Details of injured worker (skip section if more than 1 injured, use WAIR-B instead) o WAIR B used
Name of injured worker: Age: Sex:
Worker Address: Employment Status:
Average Weekly Wage: Length of service in Establishment:
Current work: Work hours/day: Work day/week:
Amount of time spent at current work: Years: Months: Days:
Body Part/s affected (indicate if left or right):
Extent of Disability: Permanent Total Permanent Partial Temporary Total
Hospitalization cost: Lost work days due to injury:
Return to work date: Nature of Injury:
Section IV. Cost of Accident
Approximate Cost to Operations (include cost of halting of production and cost to resume activities):
Less than Php 5,000 30,001 to 100,000 500,001 to 1,000,000
5,001 to 30,000 100,001 to 500,000 More than 1,000,000
Was there any damage to properties, materials or machinery? Yes No
Approximate Total Cost of Accident (Include expenses from Hospitalization, Cost to Operations,
Machinery repair and replacement, Compensation, Penalties, and Burial):
Less than Php 5,000 30,001 to 100,000 500,001 to 1,000,000
5,001 to 30,000 100,001 to 500,000 More than 1,000,000
We hereby certify that the information above is accurate to the best of our knowledge. We understand that the
OSH Standards states that these report shall not be admissible as evidence in any action or judicial
proceedings in respect to such injury, fitness or death on account of which report is made and shall not be
made public or subject to public inspection except for prosecution for violations under this Rule.
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WAIR-A
event
None
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DOLE-BQF-WAIR
AIR B used
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DOLE-BQF-WAIR
We hereby certify that the information above is accurate to the best of our knowledge. We understand that this document is covered by the Data Privacy of 2012 and
that the Data Protection Officer or Data Privacy Manual was consulted on how to record, store and dispose this form.
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DOLE-BQF-WAIR
We hereby certify that the information above is accurate to the best of our knowledge. We understand that this document is covered by the Data Privacy of
2012 and that the Data Protection Officer or Data Privacy Manual was consulted on how to record, store and dispose this form.
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ILO Occupational Safety and Health Act, Dangerous Occurences, 2016
Category Description
D1 Lifting Machinery The Collapse of, the overturning of, or the failure of any load-bearing part of any (a) hoist; (b) crane or derrick; © mobile powered access
platform; (d) access cradle or window-cleaning cradle; (e) excavator; (f) pile-driving frame or rig having an overall height, when
operating, of more than 7 meters; or (g) fork lift truck.
D2 Pressure systems The failure of any closed vessel (including a boiler or boiler tube) or of any associated pipework, in which the internal pressure was
above or below atmospheric pressure, where the failure has the potential to cause death of any person.
D3 Freight Containers The failure of any freight container in any of its load bearing while it is being raised, lowered or suspended.
D4 Overhead electric Any unintentional incident in which plant or equipment either (a) comes into contact with an uninsulated overhead electric line in which
lines the voltage exceeds 200 volts; or (b) causes an electrical discharge from such an electric line by coming into close proximity to it.
D5 Electrical short circuit Electrical short circuit or overloaded attended by fire or explosion which results in the stoppage of the plant involved for more than 24
hours or which has the potential to cause the death of any person.
D6 Explosives Any incidents involving explosives including (a) the unintentional explosion or ignition of explosives other than (i) the one caused by the
unintentional discharge of a weapon where, apart from the unintentional discharge, the weapon and explosives functioned as they were
desgined to do; or (ii) where a fail-safe device or safe system of wok functioned so as to prevent an person from being injured in
consequence of the explosion or ignition; (b) a misfire (other than one at a mine or quarry or inside a well or one involving a weapon)
except where a fail safe device or safe system of work functioned so as to prevent any person from being endangered in consequence
of the misfire; (c) the failure of the shots in any demolition operation to cause the intended extent of collapse or direction of fall of a
building or structure; (d) the projection of material (other than at a quarry) beyond the boundary of the site on which the explosives are
being used or beyond the danger zone in circumstances such that any person was or might have been injured thereby; (e) any injury to
a person (other than at a mine or quarry or one otherwise reportable under these Rules) involving first-aid or medical treatment resulting
from the explosion or discharge of any explosives or detonator.
D7 Biological agents Any accident or incident which resulted or could have resulted in the release or escape of a biological agent likely to cause severe
human infection or illness.
D8 Malfunctions of Any incident in which(a) the malfunction of a radiation generator or its ancillary equipment used in fixed or mobile industrial radiography,
radiation generators the irradiation of food or the processing of products by irradiation, causes it to fail to deenergize at the end of the intended exposure
period; or (b) the malfunction of equipment used in fixed or mobile industrial radiography or gamma irradiation causes a radioactive
source to fail to return to its safe position by the normal means at the end of the intended exposure period.
D9 Breathing apparatus Any incident in which breathing apparatus malfunctions(a) while in use, or (b) during testing immediately prior to use in such a way that
had the malfunction occurred while the apparatus was in use it would have posed a danger to the health or safety of the user.
D10 Diving operations Any of the following incidents in relation to a diving operation(a) the failure or the endangering of (i) any lifting equipment associated with
the diving operation, or (ii) life support equipment, including control panels, hoses and breathing apparatus, which puts a diver at risk;
(b) any damage to, or endangering of, the dive platform, or any failure of the dive platform to remain on station, which puts a diver at
risk; (c) the trapping of a diver; (d) any explosion in the vicinity of a diver; or (e) any uncontrolled ascent or any omitted decompression
which puts a diver at risk.
D13 pipelines or pipeline The following incidents in respect of a pipeline or pipeline works(a) the uncontrolled or accidental escape of anything from, or inrush of
works anything into, a pipeline which has the potential to cause the death of, major injury or damage to the health of any person or which
results in the pipeline being shut down for more than 24 hours; (b) the unintentional ignition of anything in a pipeline or of anything
which, immediately before it was ignited, was in a pipeline; (c) any damage to any part of a pipeline which has the potential to cause the
death of, major injury or damage to the health of any person or which results in the pipeline being shut down for more than 24 hours; (d)
any substantial and unintentional change in the position of a pipeline requiring immediate attention to
safeguard the integrity or safety of a pipeline; (e) any unintentional change in the subsoil or seabed in the vicinity of a pipeline which has
the potential to affect the integrity or safety of a pipeline; (f) any failure of any pipeline isolation device, equipment or system which has
the potential to cause the death of, major injury or damage to the health of any person or which results in the pipeline being shut down
for more than 24 hours; or
(g) any failure of equipment involved with pipeline works which has the potential to cause the death of, major
injury or damage to the health of any person.
D14 Collapse of building Any unintended collapse or partial collapse of(a) any building or structure (whether above or below ground) under construction,
or structure reconstruction, alteration or demolition which involves a fall of more than 5 tons of material; (b) any floor or wall of any building (whether
above or below ground) used as a place of work; or (c) any false-work.
D15 explosion or fire An explosion or fire occurring in any plant or premises which results in the stoppage of that plant or as the case may be the suspension
of normal work.
D16 escape of flammable (1) The sudden, uncontrolled release (a) inside a building of(i) 100 kilograms or more of a flammable liquid, (ii) 10 kilograms or more of a
substances flammable liquid at a temperature above its normal boiling point, or (iii) 10 kilograms or more of a flammable gas; or (b) in the open air,
of 500 kilograms or more of any of the substances referred to in sub-paragraph (a).
D17 escape of substances The accidental release or escape of any substance in a quantity sufficient to cause the death, major injury or any other damage to the
health of any person.
D18 Except for Dangerous Occurences in relation to mines, quarries and Offshore workplaces are not included
B Work that deals with the extraction of minerals occuring naturally as solid (coal and ores), liquids (petroleum) or gases (natural gas).
Extraction can be achieved by different methods such as underground or surface mining, well operation, seabed mining, etc. Also
Mining and Quarrying includes supplementary activities aimed at preparing the crude materials for marketing, for example, crushing, grinding, cleaning, drying,
sorting, concentrating ores, liquefaction of natural gas and agglomeration of solid fuels.
C Work that includes physical or chemical transformation of materials, substances or componenets into new products. The raw materials
Manufacturing are products of agriculture, forestry, fishing, mining or quarrying as well as products of other manufacturing activities. Substantial
alteration, renovation or reconstruction of goods is generally considered as manufacturing.
D Electricity, gas, steam Work that includes the activity of providing electric power, natural gas, steam, hot water and the like through a permanent infrastructure
and air conditioning (network) of lines, mains and pipes. Also included are the distribution of electricity, gas, steam, hot water and the like in industrial park or
supply residential buildings. Also included are the operation of electric and gas utilities, which generate, control and distribute electric power or
gas. Also included is the provision of steam and air-conditioning supply.
E Water supply, Work related to the management of various forms of waste such as solid or non-solid industrial or household waste, as well as
sewerage, waste contaminated sites. The output of the waste or sewage treatment process can either be disposed of or become an input into other
management and production processes. Activities of water supply are also grouped in this section since they are often carried out in connection with, or by
remediation activities units also engaged, in the treatment od sewage.
F Includes work in general construction and specialized construction activities for buildings and civil engineering works. It includes new
Construction work repair, additions and alterations, the erection of prefabricated buildings or sturctures on the site and also contruction of a temporary
nature.
G Includes wholesale and retail sale (sale without transformation) of any type of goods and the rendering services incidental to the sale of
Wholesale and Retail
these goods. Also included is the rapair of motor vehicles and motorcycles. Sal without transformation is considered to include the usual
Trade; Repair of
operations (or manipulations) associated with trade, for example, sorting, grading and assembling of goods, mixing (blending) of goods
Motor Vehicles and
(ex. sand), bottling, packing, breaking bulk and reoacking for distribution in smallet lots, storage, cleaning and drying of agricultural
Motorcycles
products, cutting out of wood, fibreboards or metal sheets as secondary activities.
H Includes work that provides passenger or freight transport, whether scheduled or not, by rail, pipeline, road, water or air and associated
Transportation and
activities such as terminal and parking facilities, cargo handling, storage etc. Also included are work that deals with the renting of
Storage
transport equippment with driver or operator and the postal and courier activities.
I Accomodation and Includes work that provides short-stay accomodation for visitors and other travelers and the provision of complete meals and drinks fit
Food Service for immediate consumption. Excludes work related to real estate or manufacturing of packed food or drinks not for immediate
Includes work that deals with the production and distribution of information and cultural products, the provision of the means to transmit
Activities consumption.
J or distribute these products, as well as data or communications, information technology activities and the processing of data and other
Information and
information service activities. Publishing includes the acquisition of copyrights to content (information products) and making this content
communication
available to the general public by engaging in (or arranging for) the reproduction and distribution of this content in various forms (print,
electronic or audio form, on the internet, or as multimedia products).
P
Includes work in education at any levels or for any profession, oral or written as well as radio and television or other means of
commuincation. It includes education by the different institutions in the regular school system at its different level as well as adult
Education
education, literacy programmes, etc. Also included are military schools and acdemies, prison school, etc. at their respective levels. This
also includes public and private education, sport and recreational activities as well as education support activities.
Q Includes work invloved in the provision os health and social work activities, involving a wide range of activities, starting from health care
Human Health and
provided by trained medical professional in hospitals and other facilities, over residential care activities that still involve a degree of
social work activities
health care activitis to social work activities without any involvement of health care professionals
R Arts, entertainment Includes work to meet varied cultural, entertainment and recreational interest of the general public, including live performnaces,
and recreation operation of museum sites, sports, gambling and recreation activities.
S Other service Includes work of membership organizations, repair of computers and personal household goods and a variety of personal service
activities activities not covered elsewhere in the classification.
T
Activities of
households as
employers;
undifferentiated
as described in the category.
goods and services
producing activities of
households for own
use
U Activities of
extraterritorial
as described in the category.
organization and
bodies
C7 Superficial injuries Includes abrasions, scratches, blisters, bites of non-venomous insects, superficial wounds; also includes superficial injuries to foreign bodies entering
the eye.
C8 Contusions and Includes hemarthrosis, hematoma and bruises; contusions and crushing associated with superficial injuries. Excludes concussions; contusions and
crushing crushing with fracture; and contusions and crushing with an open wound.
C9 Burns Includes burns from hot objects; from fire; scalds; friction burns; radiation burns (infrared); chemical burns (external burns only); burns with open wound.
Excludes burns due to swallowing a corrosive or caustic substance; sunburns; effects of lightning; burns due to electric current; and radiation effects
other than burns.
C10 Acute poisonings Includes the acute effects of the injection, ingestion, absorption or inhalation of toxic, corrosive or caustic substances; bites of venomous animals;
asphyxiation by carbon monoxide or other toxic gases. Excludes external chemical burns.
C11 Effects of weather Includes effects of reduced temperature (frostbite); the effects of heat and insulation (heatstroke, sunstroke); barotrauma (effects of high altitude,
exposure, and related decompression); the effects of lightning; sound trauma (total or partial loss of hearing as a separate injury, not a sequela of another injury).
conditions
C12 Asphyxia Includes drowning, asphyxiation or suffocation by compression, constriction or strangulation; also includes asphyxiation by suppression or reduction of
oxygen in the surrounding atmosphere and asphyxiation by foreign bodies in the respiratory tract. Excludes asphyxiation by carbon monoxide or other
toxic gases.
C13 Effects of electric Includes electrocution, electrical shock and burns due to electric currents. Excludes burns caused by hot parts of electrical appliances (70) and the
currents effects of lightning.
C14 Effects of radiations Includes effects caused by X-rays, radioactive substances, ultraviolet rays, ionizing radiations. Excludes burns due to radiations and sunstroke.
C15 Multiple injuries of This group should be used only for cases where the injured person sustained several injuries of a different nature and no injury is obviously more severe
different nature than the others. In a case of multiple injuries suffered in one accident where one of the injuries is obviously more severe than the others, then this
accident should be classified in the group corresponding to the nature of the more obviously severe injury.
C16 Other and unspecified This group should only be used to classify injuries which cannot be classified elsewhere, such as infections. Includes various early complications of
injuries trauma and pathological reactions which should be classified in this group only when the nature of the antecedent injury is unknown.