CONS@ROJO

CHECSAC-CCCC4TH
SISTEMA DE GESTIÓN DE SEGURIDAD, SALUD Y M
HEALTH, SAFETY ANDA EL VIRONMENT IVIANAG

PRELIMINARY REP
Code: HSE-REG-000

lÆ2021
Project:
EVENT
Incident Incident with First Aid Incident Haz
Incident Occupational Disease
Minor Accident Disabling Accident F-ata
AREA - SG Occupational Safety Occupational H
TYPE OF DAMAGE/DAMAGE Personales Materia ls
WO RK / PROJECT Construction of the Operation 2one (2OP) and the Entrance Com
DATE 4/09/2023 HORA 08:15:00 LOCATION
EVENT Own (Con sorcio+CHECSAC-CCCC4TH) Contra c
NOMBRES Y APELLIDOS DE LOS INVOLUCRADOS DIREC
Roger Narvasta Liberato
 CARGO
Carpenter Operator
 AREA
Operations
What happened? St fetch in the waist due to Jo Iced posture
At 08:1S am, the worker Roger Narvasta Liberato identified with DNI No. 4432
clearance for the formwork of frieze, at the time of assembling the formwork
waist, where he went to the clinic for medical evaluation. The worker receive
Inadequate task position
Date Time
4/09/2023 08:00 Material supply for frieze formwork.B
Detail
 Responsible
Ran Jing Yong-Foreman
4/09/2023 08:15 Worker suffers stretched waist due to forced postu
4/09/2023 09:15 First aid care
4/09/2023 10:00 Incident report.
Detail
Start of event investigation
Roger Narva sta Liberato-carpenter operator
Santiago Hidalgo-Occupational Physician
Juan Salvatierra - HSE Superviser
Responsible
Juan Salvatierra - HSE Superviser
Location at formwork mater ial
Formwork material qualification
Stretching of the waist due to forced
posture
Primary care for workers
Incident with minor material damage under investigation.
REPORTER
Ju an Salvatierra Llallahui
DATE 4/09/2023Escaneado con CamScanne