‫م‬.‫م‬.‫ذ‬.

‫شر كة بيس للمقاوالت العامة ش‬

Base General Contracting Company L.L.C

INCIDENT REPORT FORM

Use this form to report accidents, injuries, medical situation, or behavior incidents. Instantly notify management and HR of any event.

Ref. No. : Date of Report: Time: 11:00 AM

Reported by: Eng. Mohd Fadel Project Name: 2023/57 Improvement of Al Khor St., UAQ

INCIDENT INFORMATION
Activity Name:
Place of the activity : Al Khor St., UAQ Specific Location:
Date of the incident: Time of the incident: 11:00 AM
Person in-charge: Phone Number:
Description of the incident:

Photos (if any)

Name and Designation of Other Persons Involved: Phone Number:

-
-
-
-
-
Emergency Services or Police called? Yes No (Attach evidence or reference if any)

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 ‫م‬.‫م‬.‫ذ‬.‫شر كة بيس للمقاوالت العامة ش‬
Base General Contracting Company L.L.C

ATTACHMENTS
Ref. No. : BGC-IR-000

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 ‫م‬.‫م‬.‫ذ‬.‫شر كة بيس للمقاوالت العامة ش‬
Base General Contracting Company L.L.C

INCIDENT REPORT FORM

Use this form to report accidents, injuries, medical situation, or behavior incidents. Instantly notify management and HR of any event.

Ref. No. : BGC-IR-001 Date of Report: Jul 13, 2024 Time: 1:30 PM
Reported by: Eng. Mohd Fadel Project Name: 2023/57 Improvement of Al Khor St., UAQ

INCIDENT INFORMATION
Activity Name:Formation of carriageway
Place of the activity : Al Khor St., UAQ Specific Location: 25.582320,55.576689
Date of the incident: Jul 13, 2024 Time of the incident: 1:30 PM
Person in-charge: Eng. Ajmal Mohamed Phone Number: 0521791995
Description of the incident:
Upon doing the formation of carriageway, our team has accidentally damaged the fiber cable which
was found only 20 cm from OGL (not as per standard depth of Etisalat cable).

Photos (if any)

Name and Designation of Other Persons Involved: Phone Number:

- Foreman
- Operator
- Helper
-
-
Emergency Services or Police called? ✘ Yes No (Attach evidence or reference if any)
We had notified Etisalat representative, Eng. Asad Abdul Lalif. Please see attached filled out and
signed undertaking form for further details.

799701950.xlsx Page 3 | 9
We had notified Etisalat representative, Eng. Asad Abdul Lalif. Please see attached filled out and
signed undertaking form for further details.
‫م‬.‫م‬.‫ذ‬.‫شر كة بيس للمقاوالت العامة ش‬
Base General Contracting Company L.L.C

ATTACHMENTS
Ref. No. : BGC-IR-001

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 ‫م‬.‫م‬.‫ذ‬.‫شر كة بيس للمقاوالت العامة ش‬
Base General Contracting Company L.L.C

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 ‫م‬.‫م‬.‫ذ‬.‫شر كة بيس للمقاوالت العامة ش‬
Base General Contracting Company L.L.C

INCIDENT REPORT FORM

Use this form to report accidents, injuries, medical situation, or behavior incidents. Instantly notify management and HR of any event.

Ref. No. : BGC-IR-002 Date of Report: August 9, 2024 Time: 10:00 AM

Reported by: Eng. Mohd Fadel Project Name: 2023/57 Improvement of Al Khor St., UAQ

INCIDENT INFORMATION
Activity Name:Excavation for laying of future ducts
Place of the activity : Al Khor St., UAQ Specific Location: 25.5865998,55.5774968

Date of the incident: Aug 9, 2024 Time of the incident: 10:00 AM

Person in-charge: Eng. Ajmal Mohamed Phone Number: 0521791995
Description of the incident:
The team was assigned to do excavation for laying of Etihad Water future ducts and has damaged
the duct by accident which caused leakage on the same area of the pit.

Photos (if any)

Name and Designation of Other Persons Involved: Phone Number:

- Foreman
- Operator
- Helper
-
-
Emergency Services or Police called? ✘ Yes No (Attach evidence or reference if any)

We notified and reported the incident to Etihad Water thru their website and has received
reference number for the request as attached.

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We notified and reported the incident to Etihad Water thru their website and has received
reference number for the request as attached. ‫م‬.‫م‬.‫ذ‬.‫شر كة بيس للمقاوالت العامة ش‬
Base General Contracting Company L.L.C

ATTACHMENTS
Ref. No. : BGC-IR-002

799701950.xlsx Page 7 | 9
 ‫م‬.‫م‬.‫ذ‬.‫شر كة بيس للمقاوالت العامة ش‬
Base General Contracting Company L.L.C

INCIDENT REPORT FORM

Use this form to report accidents, injuries, medical situation, or behavior incidents. Instantly notify management and HR of any event.

Ref. No. : BGC-IR-003 Date of Report: August 22, 2024 Time: 11:00 AM
Reported by: Eng. Mohd Fadel Project Name: 2023/57 Improvement of Al Khor St., UAQ

INCIDENT INFORMATION
Activity Name:Formation of carriageway
Place of the activity : Al Khor St., UAQ Specific Location: 25.5865998,55.5774968
Date of the incident: Aug 22, 2024 Time of the incident: 11:00 AM
Person in-charge: Eng. Ajmal Mohamed Phone Number: 0521791995
Description of the incident:
As the team was doing the formation of the carriageway, they have accidentally damaged Etisalat
duct which caused the cable to be exposed and damaged as well. Please note that the cable which
was found only 20cm from OGL is not as per standand depth.

Photos (if any)

Name and Designation of Other Persons Involved: Phone Number:

-
-
-
-
-
Emergency Services or Police called? Yes ✘ No (Attach evidence or reference if any)

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 ‫م‬.‫م‬.‫ذ‬.‫شر كة بيس للمقاوالت العامة ش‬
Base General Contracting Company L.L.C

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