ACCIDENT INVESTIGATIVE REPORT

Date : June 24, 2022

Time: 4.00 p.m.

Name : Samantha Lim

Home Address: P-4 John Bosco District, Mangagoy, Bislig City

INJURY

Type of Bodily injury : Broken right arm, bruised thigh and hip

Location of the Incident: Prince Town located in R. B Castillo Street, Mangagoy, Bislig City,

8311 Surigao Del Sur

Narrative Report:

On Friday afternoon, June 24,2022, at 4p.m. in Prince Town located in R. B Castillo Street,

Mangagoy, Bislig City, 8311 Surigao Del Sur, Samantha Lim was stacking shelves while standing

on a ladder in order to reach the top shelf of handbags.

As she was stretching to place a bag on the shelf, the ladder collapsed from under her, and she fell

to the ground. Her co-worker heard the loud noise and immediately helped her. Samantha was in

a lot of pain and could not get to her feet as she felt lightheaded. An ambulance was phoned, and

she was brought to hospital. Samantha obtained a broken right arm, bruised thigh and hip, and a

bump to the head that left no major head injury. She was recommended three weeks off work at
the minimum by doctors.

The fall was concluded to be of nobody else’s fault but was put down to Samantha accidently

overreaching instead of moving the ladder to where she needed to see.

Emergency medical treatment given: YES

Name of Hospital: Andres Soriano Memorial Hospital Cooperative

Describe procedure(s) : A fiber cast was installed on her right arm in order to avoid further

damage due to a cortical break in her right wrist.

Cost of Injury: She incurred Php 4,000 for the operation but subject for increment as she has to

undergo follow-up checkup after the removal of the fiber cast.

Prepare by:

Joy Suzanne S. Avila

Jean Nikka Gales