laporan kemalangan 5 jam & 24 jam 19.03.2014

8/12/2019 Laporan Kemalangan 5 Jam & 24 Jam 19.03.2014

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From: SOM Transnasional Southern South

To: SHE Officer and SHE Administrators

No.Immediate Submission by

SMSSubmission within 5 hours in writing by fax or email

1 Company (as per bus permit) Company (as per bus permit) : TRANSNASIONAL EXPRESS SDN BHD2 Occurrence details Occurrence details :

3 Date of accident Date of accident : 19/3/2014

4 Time of accident Time of accident : 2.15 AM

5 Location of accident Location of accident : PERSIMPANGAN LAMPU ISYARAT PEKAN KUALA PILAH

6 Driver/s name Driver/s name :TD 1417 MAZLAN BIN SALLEH

7 Driver/s workstation Driver/s workstation : MERSING

8 Bus plate number Bus plate number : WPR 1826

9 Casualty (Driver/s) Casualty (Driver/s) :NIL

10 Casualty (Passengers) Casualty (Passengers) : NIL

11 Driver's Supervisor : EN SHUKRI@TERUNA BIN HASSAN : Hp No: 019-7020818

12 Route : MERSING - PUTRAJAYA

13 OMO or 2 men operations : OMO

14 Working Hours : 4.30 HRS15 Previous day working record schedule : SAME

16 No. of passengers during the accident : N/AV

17 No. of trip on the accident day : 4

18 Accident occurred during which trip : 1ST TRIP

19 Summons Status (Bus) : TBA

20 Summons Status (Driver) : TBA

21 Driver Duty Status : ON DUTY

22 Description of accident : ( MINOR accident )

23 Other mattersBas tidak boleh beroperasi untuk buat pembaikan. Pemandu akan dihantar segera ke

KTB untuk siasatan

Pemandu Ketika Kejadian:-

Nama : TD 1417 MAZLAN BIN SALLEH

K/Pengenalan: 670919015391

Prepared By : TERUNA @ MOHD SHUKRI BIN MD HASSAN ( APS )

Date : 20/3/2014


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To: KTB SHE Officer and KTB SHE Administrators Fax No. : 03-40477888

(Must be submitted within 24 hours after accident)

a. Company :

(as per bus permit)

b. Brand : TRANSNASIONAL

c. Driver 1 : Driver 2:

(Driving during Accident)

d. Region/Sector :

e. SOM :

f. Branch :

g. Destination : From : To :

h. Type of Operations :

i. Bus Permit :

j. * Replacement Bus : * Replacement ( )

Registration No.

k. Bus Information : Registration No.

Bus Model / Size

Bus Type

l. Date of Accident : Time of Accident :

m. Type of Accident : Major ( )

n. Location of Accident :

o. Description :

Minor ( / )

PERSIMPANGAN LAMPU ISYARAT PEKAN KUALA PILAH, NEGERI SEMBILAN

NISSAN

19.03.2014 2.15AM

Original ( / ) LPS ( )

N/A

WPR 1826

MERSING

MERSING PUTRAJAYA

Express ( / ) Charter ( ) Stage ( ) Others ( )

MAZLAN BIN SALLEH OMO

SOUTHERN SOUTH

ISMAIL ABD AZIZ

APPENDIX 3

ACCIDENT REPORT - Within 24 hours

KONSORTIUM TRANSNASIONAL BERHAD

PADA 19/3/2014 JAM LEBIH KURANG 2.15AM, SAYA MEMANDU BAS BERNOMBOR

WPR 1826 DARI MERSING HENDAK KE KUALA LUMPUR BERSAMA 10 PENUMPANG.APABILA SAMPAI DI LAMPU ISYARAT MCA KUALA PILAH, LAMPU BERTUKAR MERAH

DAN SAYA TERUS MEMBERHENTIKAN BAS. TIBA-TIBA DATANG SEBUAH MOTOR LORI

NOMBOR WVA 2277 DARI ARAH BELAKANG TERUS MELANGGAR SEBELAH KIRI BAS

SAYA. DALAM KEJADIAN ITU SAYA TIDAK MENGALAMI SEBARANG KECEDERAAN.

KEROSAKAN PADA BAS IALAH SEMUA BAHAGIAN BELAKANG SEBELAH KIRI ROSAK.

LAMPU BELAKANG SEBELAH KIRI ROSAK, BUMPER BELAKANG KIRI ROSAK. LAIN-LAIN

KEROSAKAN BELUM DIKETAHUI.


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p. Accident Sketch :

q. Damages Description :

r. Parties Involved :

No of Driver : Casualties: No of Passengers

No of Passengers: Casualties: Casualties:

s.

SP

AD

JPJ

Po

lice

SP

AD

JPJ

Po

lice

SP

AD

JPJ

Po

lice

SP

AD

JPJ

Po

lice

t. Insurance Agent has been informed

Yes u.

No

v. If 3rd party, has authorization to repair been received: ( N/AP )

Prepared by: 20.3.14

Yes ( ) No ( )

APS SHUKRI@TERUNA BIN HASSAN Date:

by SOM Party at Fault

T/Parties

No of Outstanding Summons Amount of Outstanding

BUS Driver BUS Driver

1 TIDAK CEDERA 0

10 TIDAK CEDERA NA

Own Third Party

A. BUMPER BELAKANG KIRI ROSAK.

B. SEMUA LAMPU BELAKANG KIRI ROSAK.

PEKAN KUALA PILAH

SEREMBAN

TAMPIN

WPR 1826WVA

2277


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laporan kemalangan 5 jam & 24 jam 19.03.2014

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