ACC-2015 V1.

AYALA CENTER CEBU

INCIDENT REPORT
Date Prepared: Monday, January 02, 2017

Date of Incident: February 20,2017 Incident Relation: Property Related

Time of Incident: 0958 H Nature of Incident: Others

Incident Classification: Life and Safety Specify Others: Water Leak

Incident Sub-class: Property Damage Location of Incident: Apostrophe Level 2

Persons Injured/Involved:
Classification: Age: Gender/Status: Injury Type: Specify/Enumerate Injury:

AposropheStore Tenant/Merchant

Body Part/s: Extent of Injury: Contact No.: Address:

09352522911 Level 2 paseo cuidad

Classification: Age: Gender/Status: Injury Type: Specify Injury:

Pizza Hut Store Tenant/Merchant

Body Part/s: Extent of Injury: Contact No.: Address:

260-7228 Level 3 paseo Verde

Classification: Age: Gender/Status: Injury Type: Specify Injury:

Body Part/s: Extent of Injury: Contact No.: Address:

INCIDENT DESCRIPTION:
Details/Cause/Reason:

A certain Ivy Espantaleon ( Apostrophe / Cashier) informed Double Charlie regarding their discovery of water leak inside their store. Polystar personnel Raffy Bateller/ /Elson Bayanas with Safety Marshal
cambo verified the incident. They noticed that the source was from the leaking of Kitchen area of PIZZA HUT Store.

Observations/Actions Taken/Condition:

1. No Damaged items were declared by Apostrophe personnel Ms. Ivy Espantaleon.

2. The PIZZA HUT Store manager was informed regarding the leaking with BE. Eduard Jabenis
3. PIZZA HUT manager and BE.Eduard Jabenis to conduct color test again tonight.

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PICTURE ATTACHMENTS*:

SM.Cambo,Mary Grace 2nd Lt. DANIEL SUICO (Ret) PA CSP

Prepared by/Designation: SAFETY MARSHAL
Noted by/Designation: Detachment Commander