Scribd Logo
Upload

Welcome to Scribd!

  • 12 views

    Sample Accident Report On Site

    Uploaded by

    JP Gallardo
    Mr. Pedro Penduko was struck by a falling scaffolding pipe while working, suffering a spinal cord injury that left him permanently disabled. The accident occurred when his coworker Mr. Juan dela Cruz took a phone call and lost focus while passing the pipe down, at the same time Mr. Penduko stopped to tie his shoe, unaware of each other's actions. The report recommends not using phones or gadgets while working to prevent similar accidents caused by divided attention.

    Copyright:

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

    Sample Accident Report On Site

    Uploaded by

    JP Gallardo
    12 views2 pages
    Mr. Pedro Penduko was struck by a falling scaffolding pipe while working, suffering a spinal cord injury that left him permanently disabled. The accident occurred when his coworker Mr. Juan dela Cruz took a phone call and lost focus while passing the pipe down, at the same time Mr. Penduko stopped to tie his shoe, unaware of each other's actions. The report recommends not using phones or gadgets while working to prevent similar accidents caused by divided attention.

    Original Description:

    Sample Accident Report happened during handling of pipes.

    Original Title

    Sample Accident Report on site

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Mr. Pedro Penduko was struck by a falling scaffolding pipe while working, suffering a spinal cord injury that left him permanently disabled. The accident occurred when his coworker Mr. Juan dela Cruz took a phone call and lost focus while passing the pipe down, at the same time Mr. Penduko stopped to tie his shoe, unaware of each other's actions. The report recommends not using phones or gadgets while working to prevent similar accidents caused by divided attention.

    Copyright:

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

    Sample Accident Report On Site

    Uploaded by

    JP Gallardo
    Mr. Pedro Penduko was struck by a falling scaffolding pipe while working, suffering a spinal cord injury that left him permanently disabled. The accident occurred when his coworker Mr. Juan dela Cruz took a phone call and lost focus while passing the pipe down, at the same time Mr. Penduko stopped to tie his shoe, unaware of each other's actions. The report recommends not using phones or gadgets while working to prevent similar accidents caused by divided attention.

    Copyright:

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

    ACCIDENT REPORT

    Company Name: Group 4, Inc.


    Date of Report December 28, 2022 Time: 3:30PM

    PERSON INVOLVED
    PERSON AFFECTED:
    Full Name: Mr. Pedro Penduko SSS: xxxxx
    Designation: Scaffolder Pag-ibig: xxxxx
    Phone No.: 0933-123-4567 Philhealth: xxxxx
    PERSON RESPONSIBLE:
    Full Name: Mr. Jaun dela Cruz SSS: xxxxx
    Designation: Scaffolder Pag-ibig: xxxxx
    Phone No.: 0933-123-1234 Philhealth: xxxxx

    THE INCIDENT
    Date of Incident: December 28, 2022 Time: 10:30PM
    Location: 1234 Makikisig St., Matayog Bldg., Manila
    Describe the Incident:
    Mr. Juan dela Cruz was tasked to relay the gi pipe from the second floor to Mr. Pedro Penduko at the
    ground floor. The accident happened the moment Mr. dela Cruz took a phone call, dividing his focus and
    attention on the job, while Mr. Penduko signaled for a quick halt to tie his shoelace, simultaneously.
    Both unaware of the actions of each other, the scaffolding that Mr. dela Cruz let go struck Mr. Penduko's
    back, damaging his spinal cord which resulted to him being permanently disabled.

    Agency Involved: Scaffolding Pipe


    Accident Type: Struck by Falling Object
    Unsafe Act: Using of Cellphone while Working
    Contributing Factor: Demotivated Worker

    INJURIES
    Was anyone Injured? yes no
    If yes, described the injuries:
    Mr. Penduko suffers spinal cord injury that cause disability forelife.

    Nature of Injury: PTD (Permanent Total Disability)


    Parts Affected: Spinal Cord
    Date Disability Begun: December 28, 2022
    Date Return to Work: N/A
    Days Lost: N/A
    DaysCharged: 6000
    PREVENTIVE MEASURES
    Recommendation:
    Using of gadgets while working is not allowed.

    PHOTOS

    Prepared By:
    Group 4
    Safety Officer

    You might also like