MOCK DRILL REPORT

1. Area & Location: 3A1 Station

2. Mock drill conducted on Date:14-05-2016 Time:10:30 AM
3. Number of persons : 50
4. Emergency situation : (Mack with an X)

(1) Fire 
(2) Excavation collapse 
(3) Fall from Height o
(4) Rescue drill x
(5) Occupational Emergency 
5. Name of observer : Mr. Willy Barrera
6. Scenario :Worker fall about 1 mtr in height while doing compaction on the edge of
excavated trench
7. Time of declaration of emergency : 10:40 AM
8. Whether cordoning off area done : (Mark with an X) YES  NO 
9. Whether emergency alarm sounded : (Mark with an X) YES  NO 
10. First responder response time : 10: 46 AM
11. Whether worker assembled at assembly point: (Mark with an X) YES  NO
12. Whether ambulance/Medical staff were called, and time taken accordingly : YES
13. Time of all clear : 10:40 AM
14. Total time elapsed : Approximately 6 MINS
15. Previous total time : 10 MINS
16. Deficiency observed during the exercise :
 ambulance driver not familiar with the site route
 Heavy equipment blocking the road access
 After the execution UCCC representative unable to gather towards mastering point
 UCCC officer unable to head count after tool box
17. Action recommended for improvement:

No Recommendation Action Date

1. Give instruction to all site ANM/CWG site HSE Team ASAP
engr. To avoid blocking
route access
2. Provide adequate ANM/CWG Site Team- ASAP
directional signage's & UCCC Site team
updated route map
3. Provide more adequate ANM/CWG site HSE Team ASAP
trainings awareness for West
Depot Rescue team on how
to deal emergency cases
18. Name of person responsible to follow up, above : West Depot HSE Team, ANM/CWG Station
Manager
19. Other remarks: The drill was conducted by West Depot HSE team and UCCC Sub-
Contractor. The next emergency exercise shall be on the emergency and shall be
conducted by HSE Team and ANM CWG team.

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Mr. Willy Gilbert O. Escomo Engr. Siva Kumar N/A

Barrera
Observer(s) HSE Representative Site In Charge Client(s)

1. A safety Officer of UCCC who witness the incident immediately call the site
ambulance and together with the Emergency Rescue Team for assistance

2. Emergency rescue Team cordon the incident scene with warning tape to
prevent unauthorized entry of personnel or viewers.

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3. While waiting for the emergency team to arrive, rescue team check the
condition of IP & place to the stretcher

4. The Injured Person was then place to the stretcher to protect injured part
from his body during transfer to Ambulance.

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5. Injured Person Information such as medical ID and Company ID were

recorded as well as the time of incident, location, what part of the body injured,
location of the nearest Hospital IP to be send and his Supervisor.

6. Ambulance arrived at the Incident scene exactly 6 minutes duration from

time of calling.

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7. After the ambulance leave the scene immediately call the foreman, site engr.
& staff to conduct tool box talk discussing the incident happen & how to prevent
from recurrence

M-ANM-300000-GH00-FOR-000023 Rev 0 27 October 2015