Professional Documents
Culture Documents
Use this form to report accidents, injuries or medical situations incidents. If possible, the report should be completed within
24 hours of the event. Submit completed forms to the Office.
INFORMATION ABOUT PERSON INVOLVED IN THE INCIDENT
Full Name: MAH MUDDIN BIN AMIN
Home Address:
24E, Jalan Seremban Jaya, Taman Bukit Berlian,
Description of Incident (what happened, how it happened, factors leading to the event, etc.) Be as specific as possible
(attached additional sheets if necessary)
At 12.00 pm, I was received a call from the restaurants guard informed that my restaurant burned. At 12.30pm,
I arrived and found the firefighters are trying to put out the fire. After the fire was extinguished, it was found
that the kitchen fire caused major damage to the entire restaurant and required major equipment purchased
and interior repairs. This report are forwarded to the Bukit Berlian Fire Department.
There is no individual injured since the incident happen after restaurant closed.
REPORTER INFORMATION
Individual Submitting Report (print name) MAH MUDDIN BIN AMIN
Signature