SPECTRUM SECURITY SERVICES INC.

Actimed Inc. Detachment

No. 6, Hologram St., Light Industry and Science Park – I
Diezmo, Cabuyao City, Laguna

FOR : MS. EMELINA A. CREUS REF. NO. INF2016-001

Warehouse&Logistics Manager
Actimed Inc.

SUBJECT: INFORMATION REPORT

Re: Electric Power Service Interruption (Bay E Mezzanine Area)

DATE : January 6, 2016

*******************************************************************************************************************
This pertains to the incident transpired at Bay E Mezzanine Area on or about 0840H of this date, wherein an extension
wire without male plug was inserted its peeled connecting wire into an electrical outlet at said area and might cause of
power service interruption and tripped a branch of circuit breaker situated at Electrical Room/Control Panel, Bay E,
affecting all outlets at said location

That based an incident report of Mr. Manuel Dela Cruz, Actimed Inc. Facility/Maintenance on Duty, Mr. Primo Repato,
Lead Man of KMG Builders asked assistance due to unavailability of electric power at said location, as one of their
workers was tapped an extension cord without male plug, causing to a possible short circuit.

That after verified the possible root cause of electric power service interruption. Mr. Dela Cruz reset to normal the
reported tripped-off circuit breaker and he personally advised the KMG Builders Team Leader for the attachment of
male plug to all of their electrical tools/equipment to prevent repetition of same incident which possible cause of FIRE.

Note: this is a second offense/violation of KMG Builders for not complying of Company Safety Rules and Regulation
despite on reiteration of safety awareness to them.

Recommendation:

THE FOLLOWING ARE SOME GENERAL FIRE PREVENTION PRACTICES, REQUIRED FIRE SAFETY, UNDER
SEC. 1.103 OF RA 9514 / FIRE CODE OF THE PHILIPPINES

1. All ignition sources (open flames, cutting torches, spark producing equipment, electric motors, heating
equipment, etc.) should be controlled and contact with combustible and flammable materials must be avoided.
Keep all combustible materials at least five feet from such ignition sources and all flammable liquids at least
twenty feet away.
2. Extensive use of electrical extension cords should be avoided. Any damaged or frayed electrical wiring,
equipment cords, extension cords, etc. should be removed from service immediately and replaced or
repaired. Any use of flammable liquids must be done in a manner that prevents spills and prevents the
flammable liquid or its vapor or spray from coming in contact with any ignition source. All flammable liquids must
be stored in proper flammable liquid storage containers and kept in the proper storage cabinets.
3. Housekeeping and storage practices are critical to preventing fires. Any combustible materials must be stored in
neat stacks with adequate aisle space provided to prevent easy spread of fire and to allow for access to
extinguish any fire that may start. Trash, scrap, and other unnecessary combustibles must be cleaned up
immediately and placed in proper disposal containers.
4. Smoking should be prohibited in the workplace premises.

OTHERS:

1. Work Clearance Permit/Hot Work Clearance Permit must be separately issued to Contractor’s In Charge, it
depends on the nature of work/s. This serves as protection to the Contractors, Workers and Actimed Inc.
Warehouse.

For your information and perusal

Attachment:

1. Picture of outlet and extension cord (without male plug)

2. Proposed Actimed Inc. Work Clearance Permit/Hot Work Clearance Permit
3. Written Information Report of Mr. Manuel Dela Cruz

Prepared by:

SO JAMES LOWELL S. QUILALA

Officer In Charge
Actimed Inc.

Cc: Det. File

SSSI Optns.
 HOT WORK CLEARANCE PERMIT
Date Issued _______________ Time _________ Date of Expiration ______________ Time __________
Issued to ________________________________________
Designation ___________________________________
Company _________________________________ Department _______________________________
Work Area _______________________________________
Work Description (Specify) _______________________________________________________________
__________________________________________________________________________________
FIRE PREVENTIONS/PRECAUTIONS: (CHECK ALL) SPECIAL HAZARDS:
YES N/A YES N/A
____ ____ Explosive atmosphere ____ ____ Electrically Classified area
____ ____ Clear surrounding area ____ ____ Personal Protective Equipment
____ ____ Fire resistant covers in use in use
____ ____ Purge or ventilate atmosphere ____ ____ Other hazards (pls. specify);
____ ____ Working fire watch ______________________________________
____ ____ Non-working fire watch ______________________________________
____ ____ Special precautions
(if yes pls. specify )_________________________________________
_______________________________________________________________ __
FIRE SUPPRESSION PREPAREDNESS:
YES N/A
____ ____ Portable extinguisher/s at work site
____ ____ Fire hose available at work site, type; ____ Water ____ Dry Chemical

Person performing hot work:

1. ____________________________ 3. ___________________________
2. ____________________________ 4. ___________________________

SAFETY REMINDER: ___________________________________________________________________

___________________________________________________________________________________

Issued by: Approved by:

___________________________ _______________________________
 WORK CLEARANCE PERMIT
Date Issued _________________Issued to ____________________Designation ___________________
Company _________________________________ Department _______________________________
Area ___________________________________________________
Work Description (Specify) _____________________________________________________________
__________________________________________________________________________________
Work to begin (Date/Time) ____________________ Work to end (Date/Time) _____________________

Type of permit:
____ Confined Space Entry ____ Work on Live Equipment/Piping
____ Excavation ____ Repair Work
____ Electrical Work ____ Flame/Spark

Checklist of Precautions:
1. ____ Safety Orientation of all Workers
2. ____ Joint Job Site Visit
3. ____ Electrical Lock Out/Tag Out
4. ____ Clean Work
5. ____ Man Watch (Fire/Hole)
6. ____ Tool Box Meeting with Worker
7. ____ Appropriate Sign/Barrier in Work Place
8. ____ Work Area Free of Combustion and other
hazards.
9. ____ Others (Specify)

Personal Protective Equipment:

____ Goggles ____ Head and Eye Protection ____ Hearing Protection
____ Lock Out/Tag Out ____ Safety Gloves ____ Fire Extinguishers
____ Face Protection ____ Fall Protection ____ Others (Specify)

SAFETY REMINDER: ___________________________________________________________________

___________________________________________________________________________________

Approved by:

Issued by: Approved by:

___________________________ ______________________________
 ELECTRICAL OUTLET

EXTENSION CORD WITHOUT MALE PLUG (AGAIN)