ACCIDENT AND INCIDENT REPORT

The Construction of Bridge in Koumongou, District of Mango, Republic of Togo

SECTION 1 : DETAILS OF ACCIDENT

Injury X Damage Only Near miss/ unsafe condition

Date : 23-Feb-2019 Time : 9:05 AM Location : A1 Gabion Work

Describe how the accident occurred:

On 23rd February 2019 at 9:05 A.M., the Superstructure Team was dismantling the Gantry Crane at P2.
While removing the Horizontal Upper Part of the Gantry Crane, the Vertical Part (Left-Side) accidentally fell on
the ground. The cable supporting the Gantry Crane which was anchored on A1 was taken out. Mr. Abdulkarim
Anual who was working at A1 Gabion Work, was hit by that cable. He was rushed to the Hospital immediately.
He underwent X-Ray and the Doctor said there was no bone fracture, just a strain on his upper back area
where that cable hit. He was given some medicine to take and was advised to rest for at least 7 days. All
activities on site were temporarily suspended for that day.

List any protective clothing or equipment being used:

Hard hat, Reflectorized Vest, and Safety Shoes

SECTION 2 : DETAILS OF INJURED PERSON

Full Name : Mr. Abdulkarim Annual Age : 36 years old
Birth Date : 17.Feb.1983 Job Title : Carpenter/ Mason
Nationality : Filipino Home Address: Tandubas, Tawi-Tawi, Philippines

Staff X Skilled Worker Labourer Visitor

Describe type and position of injury :

At the back - Upper Part

SECTION 3 : PHOTOS
SECTION 3 : PHOTOS (Continuation)
T AND INCIDENT REPORT
e in Koumongou, District of Mango, Republic of Togo

A1 Gabion Work

the Superstructure Team was dismantling the Gantry Crane at P2.

of the Gantry Crane, the Vertical Part (Left-Side) accidentally fell on
y Crane which was anchored on A1 was taken out. Mr. Abdulkarim
, was hit by that cable. He was rushed to the Hospital immediately.
here was no bone fracture, just a strain on his upper back area
edicine to take and was advised to rest for at least 7 days. All
ed for that day.

Reflectorized Vest, and Safety Shoes

PERSON

Tandubas, Tawi-Tawi, Philippines

At the back - Upper Part