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    Incident Report (Backhoe)

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    Enegue Nilyab Soled Seyer
    On October 12, 2022 at 4:00 PM, a backhoe operator accidentally broke the two side window glasses of the backhoe due to vibration while breaking existing pavement at the project site. The broken glasses were cleaned to avoid accidents and the incident was reported immediately to the supervisor and motorpool supervisor. An incident report was filled documenting the details of the incident and follow-up actions taken.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Incident Report (Backhoe)

    Uploaded by

    Enegue Nilyab Soled Seyer
    108 views2 pages
    On October 12, 2022 at 4:00 PM, a backhoe operator accidentally broke the two side window glasses of the backhoe due to vibration while breaking existing pavement at the project site. The broken glasses were cleaned to avoid accidents and the incident was reported immediately to the supervisor and motorpool supervisor. An incident report was filled documenting the details of the incident and follow-up actions taken.

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    INCIDENT REPORT (BACKHOE )

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    On October 12, 2022 at 4:00 PM, a backhoe operator accidentally broke the two side window glasses of the backhoe due to vibration while breaking existing pavement at the project site. The broken glasses were cleaned to avoid accidents and the incident was reported immediately to the supervisor and motorpool supervisor. An incident report was filled documenting the details of the incident and follow-up actions taken.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    108 views2 pages

    Incident Report (Backhoe)

    Uploaded by

    Enegue Nilyab Soled Seyer
    On October 12, 2022 at 4:00 PM, a backhoe operator accidentally broke the two side window glasses of the backhoe due to vibration while breaking existing pavement at the project site. The broken glasses were cleaned to avoid accidents and the incident was reported immediately to the supervisor and motorpool supervisor. An incident report was filled documenting the details of the incident and follow-up actions taken.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    INCIDENT REPORT

    REPORTED BY: EUGENE B. DELOS REYES DATE OF REPORT: OCTOBER 13 ,2022

    TITLE / ROLE: SITE ENGINEER INCIDENT NO.: 1

    INCIDENT INFORMATION

    INCIDENT TYPE: DAMAGE OF PROPERTY DATE OF INCIDENT: OCTOBER 12,2022

    PROJECT: PAVEMENT REPAIR @ CONTAINER YARD (PHASE 5)


    LOCATION: NPI-CDO TIME: 4:00 PM ZIP CODE:

    SPECIFIC AREA OF LOCATION (if applicable): CONTAINER YARD (AREA H6)

    INCIDENT DESCRIPTION

    ON OCTOBER 12 ,2022 AT AROUND 4 :00 PM , BACKHOE (CASE) OPERATOR MR. JESTONY SILIACAY,WHILE
    BREAKING THE EXISTING PAVEMENT SUDDENLY THE TWO SIDE WINDOW GLASS (RIGHT AND LEFT SIDE)
    ACCIDENTALLY BROKE DUE TO VIBRATION.

    NAME / ROLE / CONTACT OF PARTIES INVOLVED SIGNATURE DATE

    1. MR. JESTONY SILIACAY

    2.

    3.
    NAME / ROLE / CONTACT OF WITNESSES

    1. MR. JUVY UBA

    2. MR. JOY GEMOTO

    3. MR. JENELOU MAHINAY

    FOLLOW-UP ACTION

    CLEANED THE BROKEN GLASS TO AVOID ACCIDENT AND REPORT IMMEDIATELY TO ENGR. DARYL PAYOT
    AND TO THE MOTORPOOL SUPERVISOR MR. BOBBY DUETEZ REGARDING THE SAID INCIDENT.

    SUPERVISOR EUGENE B. DELOS SUPERVISOR


    NAME: REYES SIGNATURE: DATE:
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