DOCUMENT CODE

PMOA-AINRI-01112023

TITLE REVISION NO. PAGE

ACCIDENT/INCIDENT/NEAR MISS REPORT AND 0 1 OF 2
INVESTIGATION
PREPARED BY: REVIEWED BY: EFFECTIVITY DATE NEXT REVIEW DATE
1/10/2023
ROEL R. DOCENA REZON A. MANAL
CASCOR Safety Officer PPA Chief Safety Officer

DATE OF INCIDENT/TIME REPORT NO.

Jan.10,2023/2345H
LOCATION OF INCIDENT UNIT CONCERNED
Masao Electrical Outlet

INJURY/ILLNESS PROPERTY DAMAGE OTHER ACTUAL OR POTENTIAL LOSS

INJURED’S NAME PROPERTY DAMAGE TYPE

N/A Electrical outlet N/A
PART OF BODY DAYS NATURE OF DAMAGE COST
N/A LOST Short circuit(Burned)

NATURE OF INJURY/ILLNESS COST/ESTIMATED/ACTUAL NATURE OF LOST

N/A Waiting for the assessment N/A
OBJECT/EQUIPMENT/SUBSTANCE/INFLICTING OBJECT/EQUIPMENT/SUBSTANCE/INFLICTING OBJECT/EQUIPMENT/SUBSTANCE/RELATED
HARM HARM N/A
N/A Outlet
PERSON IN MOST CONTROL OF ITEM PERSON IN MOST CONTROL OF ITEM PERSON IN MOST CONTROL
N/A N/A N/A
DESCRIBE HOW THE EVENT OCCURRED
At around 11:45PM, CASCOR security guard Dioquino, JB, noticed that the electrical outlet of the Bodega at the extreme right (near exit 3)
caught fire. Due to heavy rains, electrical short circuit happened and he immediately put out the fire by applying Fire Extinguisher.

DEFINE IMMEDIATE CAUSES, WHAT SUBSTANDARD ACTION AND CONDITIONS CAUSED, COULD HAVE CAUSED OR CAUSE THE EVENT
1. Wet electrical outlet.
2. Expose/open outlet.
.
CODING OF IMMEDIATE CAUSES, CHECK ALL APPLICABLE
Substandard actions such as using defective equipment and improper lifting are common examples. Substandard conditions such as housekeeping
Restricted access and poor illumination are also common examples. Identify all those which had some bearing on the incident, then ask the question - WHY?

UNSAFE ACTIONS UNSAFE CONDITIONS

1. Operating equipment w/o authority  1. Inadequate guards of barriers

2. Failure to warn 2. Inadequate or improper protective equipment

3. Failure to secure 3. Defective tools

4. Operating at improper speed 4. Congestion or restricted action

5. Making safety device inoperable 5. Inadequate warning system

6. Removing safety devices 6. Fire and explosions hazards

7. Using defective equipment 7. Poor housekeeping disorder

8. Using equipment improperly 8. Hazardous environment conditions

gases, dusts, smokes, fumes, vapours
9. PPE properly
9. Noise exposure
10. Improper loading
10. Radiation exposure
11. Improper placement
 12. Improper lifting 11. High or low temperature exposures

13. Improper position for task 12. Inadequate or excess illumination

14. Servicing equipment 13. Inadequate ventilation

15. Horseplay

16. Under influence of alcohol and/or other drugs

*OTHERS

DOCUMENT CODE
PMOA-AINRI-01112023

TITLE REVISION NO. PAGE

ACCIDENT/INCIDENT/NEAR MISS REPORT AND 0 2 OF 2
INVESTIGATION
PREPARED BY: REVIEWED BY: EFFECTIVITY DATE NEXT REVIEW DATE
1/10/2023
ROEL R. DOCENA REZON A. MANAL
CASCOR Safety Officer PPA Chief Safety Officer

CORRECTIVE ACTION
What immediate action should be done to correct the incident/accident:
1. Report forwarded to CASCOR management.
2. Wiring inspection should be done with the proper electrical technician.
3. Exposed electrical outlet temporarily condemned.

DATE OF IMPLEMENTATION RESPONSIBLE PERSON(S) SIGN OFF WHEN COMPLETED

1/10/2023 CASCOR SO & Mgmt.
PREVENTIVE ACTION
What should be done to control the basic cause(s)?
1. Cover expose electrical outlet to rains.
2. Regular electrical wiring inspection.

DATE OF IMPLEMENTATION RESPONSIBLE PERSON(S) SIGN OFF WHEN COMPLETED

1/10/2023 CASCOR SO & Mgmt.
FOLLOW-UP/REVIEW OF EFFECTIVENESS

FINAL ACTION RESPONSIBLE PERSON SIGN OFF WHEN COMPLETED