Republic of the Philippines

ARKCONS & ELECTRICAL SERVICES, INC.

Balite drive, Buhangin Davao City, 8000 Tel. No. (082) 295-7150
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SAFETY OFFICER INCIDENT/ACCIDENT REPORT

Date & Time of Address of Incident/Accident: Type of incident: Name of Involved

Incident/ Accident: Personnel
Balite Drive Buhangin at Arkcons Accident ☒
October 12,2019 Compund Near Miss ☐ 1.Porcare Dary Rebutabo
On Duty 2. Alberto Simbrano

Time of Arrival of Safety management Site Supervisor or witness

Safety Officer: YES NO on Site:
PPE WORN
DURING INCIDENT ☐☐ 1.

WITH EYE PROTECTION ☐☐

INJURIES ☐☐

Description of Incident/Accident:

On or about 8:30 to 9:00 in the morning of October 12, 2019 thje guards on duty Mr. Alberto Simbrano was being
noticed by Mr. Karl Dominic Bajo a Division Head of the company logistic department sleeping while on duty.

Details of the incident as follows:

According to Mr. Karl Dominic Bajo a Division Head of the company’s logistic department, many times already he
noticed that the guard on duty of the company namely Mr. Porcare Dary Rebutabo and Mr. Alberto Simbrano was
not doing their designated job properly. Which includes a roving in the vicinity at any time of the day for checking,
letting employee out in the afternoon without checking, working while under the influence of liquor and sleeping
while on duty.
.

Nature and cause of Injury/Damage:

Upon investigation and questioning the involve personnel, the nature and cause of injury are as follows:

1. Hangover

Action taken to avoid future similar Incidents/Accidents:

1. Routinely inspect for the hazards.

Investigated by:
Charmie Balani, ECE
Safety Officer, OIC
Copy Furnished: GM, HR Division Head