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Accident Report Form

On February 4, 2025, an accident occurred in Tuy, Batangas involving Eduardo Catao, who accidentally backed into a parked vehicle belonging to LMA Trading and Services, resulting in property damage. Witness Carlos Bajao Jr. was present during the incident. Immediate actions included assessing the damage and checking the driver's condition, with a further investigation led by Safety Officer Rolando Ponce Jr. planned to prevent future occurrences.

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rolandonnuri1984
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80 views3 pages

Accident Report Form

On February 4, 2025, an accident occurred in Tuy, Batangas involving Eduardo Catao, who accidentally backed into a parked vehicle belonging to LMA Trading and Services, resulting in property damage. Witness Carlos Bajao Jr. was present during the incident. Immediate actions included assessing the damage and checking the driver's condition, with a further investigation led by Safety Officer Rolando Ponce Jr. planned to prevent future occurrences.

Uploaded by

rolandonnuri1984
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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LMA TRADING & SERVICES

Calibunan Cabadbaran City Agusan del Norte

Accident Report Form


ACCIDENT DETAILS:

Date and time of the Accident : February 04, 2025

Location of the Accident : Tuy, Batangas


Naibangga ni Gng. Eduardo Catao ang kanyang minamanihong
sasakyan habanag siya ay umaatras sa nakaparadang
Describe the Accident : sasakyan ng LMA Trading and Services.

Details of the witnesses, if any : Carlos Bajao Jr.

PERSON(S) INVOLVED

Name(s) : EDUARDO CATAO

COMPANY DRIVER
Job title(s) :

Nature and extend of injuries : PROPERTY DAMAGE ( INOVA CAR/COMPANY VEHICLE)

ACCIDENT CATEGORY

Vehicle or Transportation related


✘
ACCIDENT DESCRIPTION

Paatras ang minamanihong sasaakyan ni Gng. Eduardo Catao


Provide a detailed description of ng sa di inaasahan naatrasan niya ang nakaparadang company
how the accident occurred : vehicle.

IMMEDIATE ACTIONS TAKEN

Describe the immediate actions


taken to address the accident and
provide assistance :
Check how big is the damage created by the impact of the
accident. Check the condition of the driver and bring the
damage vehicle to car repair shop

CONTRIBUTING FACTORS

Were there any contributing factors to the Accident? If yes, select the relevant factors:

Unsafe Work Practices


✘

INVESTIGATION:

Will a further investigation be


conducted? : ✘ YES NO

If yes, specify the person(s)


responsible for the investigation : ROLANDO PONCE JR. Company Safety Officer

Provide any additional details or


instructions for the investigation :

PREVENTIVE MEASURES

What preventive measures can


be implemented to avoid similar
Accidents in the future? :
ADDITIONAL COMMENTS

Is there any additional information


or comments you would like to
include? :

REPORT FILTER

Name : ROLANDO PONCE JR.

Job Title / Role : SAFETY OFFICER

Contact Details : 09652118320

‘PERSON INVOLED:

EDUARD CATAO

REPORTED BY:

ROLANDO L. PONCE JR
Company Safety Officer

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