QMSU 10

Rev.0 / 9-18-17

INCIDENT REPORT FORM

IRF No. ______

DESCRIPTION OF THE INCIDENT

WHEN WHAT IMMEDIATE
(include date & (Narrative description of the occurrence, include DISPOSITION
time) concerned persons e.g. employee, customer, (What did you do?
suppliers etc.)
Parts return; Deployment of OCS
22 June,2018 1, CTRL 10x1.5mm cable wire 52 meters Support Head-Electrical
2, CTRL 10x1.5mm cable wire 52 meters
SRF 8927 -
3, CTRL 10x1.5mm cable wire 52 meters
Installation
4, CTRL 10x1.5mm cable wire 52 meters
Proposal –
5, CTRL 10x1.5mm cable wire 51 meters
CAT 2xC32
6, DATA 2x0.75mm data cable 212 meters
..Loc:
Navotas..R/b: Rally.
(NSO-074-16)

Reported by : : Michael Portugal Date: 06/22/18

Acknowledged by : Ronan Lumod, Roland Rosales, Roger Mogote Date : 06/19/18
TO BE FILLED-OUT BY CONCERNED DEPARTMENT/SECTION HEAD
Results of Investigation :

During the Installation of starting system 2xC32 M/E Layout Electrical cable wiring from M/E to ECR and ECR to
Bridge Console room. The cable tray from other contractor are loaded of wiring then we coordinated to the
owner representative to make a fabrication new cable tray for free layout cable. Conduct change of location
cable wire installation layout from M/E to ECR up to Bridge Console..

CORRECTIVE ACTION
Activity Date of Responsibility
Implementation

To be returned all existing cable wire 22-Jun-18 OCS Electrical Head

Prepared by: Emmanuel Valiao Approved by: Ernesto Portugalete Jr.

Date : 22 June 2018 Date :
 QMSU 10
Rev.0 / 9-18-17

INCIDENT REPORT FORM

IRF No. ______

RESULTS OF MONITORING OF CORRECTIVE ACTION:

For follow up on 22 July 2018

Prepared by: Emmanuel Valiao Approved by: Ernesto Portugalete Jr.

Date : 22 June 2018 Date : 22 June 2018

IRF No: IR-XXX-YY-ZZ (where XXX is the Department Code, YY is the last 2 digit of the current year,
ZZ is the running no. starting with 01)