example of INCIDENT REPORT

Air Itam Police Station
INCIDENT REPORT

A.VICTIM DETAILS:
Name : Mohd Yusof Salleh
Sex : male
Race : malay
Age: 78

B.DESCRIPTION OF THE INCIDENT:
Date: 5 April 2006
Time : 4 pm.
Location : Jalan P. Ramlee ,Penang
Equipment involved: top floor of the two-storey house
Injurys: right hand and leg

Details:
Mohd Yusof Salleh , a religious teacher was teaching the Year One student the Al-quran, suddenly heard poping sound coming from the top of floor of the two-storey house. He went up to check and saw smoke coming from one of the bedroom. So he quickly rushed back down and told the children to leave the house in an oderly manner. After that, he carried his paralysed wife and rushed out from their house. He alerted his neighbours about the fire and they tried to put the blaze by forming a bucket line.
Mohd Yusop was slightly burnt on his right hand and leg. It was happened while he was rushing out. Mohd Yusop was sent to the Penang Hospital by his son , Wan Adhaa, who rushed back home upon being informed of the fire. His father where treated as outpatient for the burns.
Four fire engine with 25 fireman arrived with help from the Paya Terubong an Air Itam voluntary fire fighting squad controlled the fire within minustes.

C. CAUSES:
After initial investigation , I discovered the causes of this incident was started by electric short circuit. A television’s socket that was used for many equipment was the factor in this case. The socket became overload and then it started to blow out.

D. RECOMMENDATIONS
To prevent similar occurrence, suggest the following:
Use a certificate socket to prevent short circuit
The fire extinguished must be provided for every house.
We must know how to take action to handle fire fighting before firemen arrived.
The firemen should take action as soon as possible to handle fire fighting.
As a follow-up, these actions have been taken:
Action no.
Description
Assigned to
Date
1.Display the details of the persons/s to contact in the event of an accident
Nearest family/ neighbours

2.Conduct a refresher course on safety procedure to provided a fire extinguished.
Kumarasamy

3.Conduct a course on efficient worker (firemen)


Reported by:
.................
( Kumarasamy @ Tony Cheng)
Senior fire officer