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    Workplace Incident Report

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    Daniel Cuñado
    Daniel A. Cuñado reported that on October 9, 2022 at 8:00 PM in Purok 2 Sinuda, Kitaotao, Bukidnon, the Hilux company vehicle he was driving received a scratch on the back door when it was slightly hit by a closed entrance door on the work site. There were no injuries in the incident. Cuñado filled out an incident report form alone without witnesses to the single-vehicle accident.

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    Workplace Incident Report

    Uploaded by

    Daniel Cuñado
    10 views1 page
    Daniel A. Cuñado reported that on October 9, 2022 at 8:00 PM in Purok 2 Sinuda, Kitaotao, Bukidnon, the Hilux company vehicle he was driving received a scratch on the back door when it was slightly hit by a closed entrance door on the work site. There were no injuries in the incident. Cuñado filled out an incident report form alone without witnesses to the single-vehicle accident.

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    incident sample report

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    Daniel A. Cuñado reported that on October 9, 2022 at 8:00 PM in Purok 2 Sinuda, Kitaotao, Bukidnon, the Hilux company vehicle he was driving received a scratch on the back door when it was slightly hit by a closed entrance door on the work site. There were no injuries in the incident. Cuñado filled out an incident report form alone without witnesses to the single-vehicle accident.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    10 views1 page

    Workplace Incident Report

    Uploaded by

    Daniel Cuñado
    Daniel A. Cuñado reported that on October 9, 2022 at 8:00 PM in Purok 2 Sinuda, Kitaotao, Bukidnon, the Hilux company vehicle he was driving received a scratch on the back door when it was slightly hit by a closed entrance door on the work site. There were no injuries in the incident. Cuñado filled out an incident report form alone without witnesses to the single-vehicle accident.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
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    WORKPLACE INCIDENT REPORT FORM

    Date of Report: October 9, 2022


    1. PERSON INVOLVED

    Full Name: Daniel A. Cuñado


    Address: Purok Papaya Landing Darong Santa Cruz Davao Del Sur
    Identification: ☒ Driver’s License No. L03-19-00010
    Phone: 09770910415
    E-Mail: cunadodaniel1@gmail.com
    2. THE INCIDENT

    Date of Incident: October 9, 2022


    Time: 8:00 ☒ PM
    Location: Purok 2 Sinuda, Kitaotao, Bukidnon
    Describe the Incident: The Hilux company vehicle got a scratch on a back door due to
    The slightly closed door in the site entrance, there were no injuries but the vehicle
    suffered a scratch.
    3. INJURIES

    Was anyone injured? ☐ Yes ☒ No


    4. WITNESSES

    Were there witnesses to the incident? ☐ Yes ☒ No


    5. POLICE / MEDICAL SERVICES

    Police Notified? ☐ Yes ☒ No


    6. PERSON FILING REPORT

    Signature: ________________________ Date: _____________

    Print Name: ________________________

    OFFICE USE ONLY

    Report received by: _____________________________ Date: __________________

    Follow-up action taken:

    Action Taken: _________________________________________________________

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