Sensitive (001 — Appendix 1 EHS - INCIDENT STATEMENT In your own words describe the circumstances leading to and of the incident. CompanyName _| GENERAL AGENCIES & | project Number [Pic R7505 | Name Benedicto Agplaza | Date & Time ofincident 20" AUGUST. 07:00AM | Employer ac Occupation DRIVER Written By KHIZAR HAYAT ~ | Injured Party Oo [Wines] oO Parties Present - ‘Statement = | Page 1 On the 30m of august at 6:00 AM, after biometric punching for my attendance, | go to my truck. | make visual inspection as | am doing every day. Everything was seems normal such as tires conditions and pressure, horn, emergency lights, breaks and all other functions are working properly. My co-drivers went to loading area and follow them to start loa dumping site around 07:00 AM for my first trip. 1am working for PIG R 7505 Project for 6 months and | am familiar with the site access and 1g. reached at garess and working site. The spotter was present at site and he assess me for dumping material. | positioned my truck at unloading area and start operating of hydraulic jack to raise the dump box and unloaded a half load of the base course material when suddenly the hydraulic cylinder snaps and had a failure. Due to the load the dump box tilted to the left side and over turned the dump truck. | immediately went out from the cabit and found site supervisor calling safety manager. By the race of GOD | didn’t get any injury. | informed transport manager for further proceedings. This statement (consisting of ...... pages, each signed by me) is true and factual to the best of my knowledge. Sanaa] ; Raa Sn Cos oa | Sratvre Winessodb aioe Name | Hfyzas Hada) Posen [ase yy. [Senate abe [2efy/zny 1 =Sensitive 001 ~ Appendix 1 EHS - INCIDENT STATEMENT In your own words describe the circumstances leading to and of the incident, CompanyName | GENERAL AGENCIES © Toe umber PIC R-7505, Name SULTAN HUSAIN Date & Timo ofincident | 30°" AUGUST. 07:00 AM Employer GAC = 7 Occupation BResviso Witten By KHIZAR HAYAT injured Party 0 [Witness |G Parties Present 7 - ‘Statement == [Page | + [or] 4 ‘On the 30» of auqust at 6:00 AM, workers are preparing for the Pre task Briefing at the job Site prior to start of hauling activities and asphalt works. Being site supervisor | was present at pump station area to give instructions to spotter for unloading base course material. Dump trucks arrival starts from 06:20. Everything was going normal. Usually 5 to 6 dump trucks are Hauling for asphalt and base course activity at site. Mr. Benedicto Agplaza one of the dump Tuck drivers arrived at the working site around 07:00 AM for his first trip. He is working for PIC R 7505 Project for 6 months and he is familiar with the site access and egress and working site. When Mr, Benedicto Aqplaza reach the dumping area he immediately unloaded a half load of the base course material when suddenly the hydraulic cylinder snaps and had a failure Due to the load the dump box tilted to the left side and over turned the dump truck. | immediately call safety manager and construction manager. The driver come out from his cabin and found no injuries. This statement (Consisting of pages each signed by me) is tue and facualto the best cfmy knowledge | 7 Site _ ‘30-August- | Name | Suten Hussin [Boston | Se any [Siunelve| 3 une | Date oA min nie en Ee =