From: SOM Transnasional Southern South

To: SHE Officer and SHE Administrators

No.
Immediate Submission by
SMS
Submission within 5 hours in writing by fax or email
1 Company (as per bus permit) Company (as per bus permit) : TRANSNASIONAL EXPRESS SDN BHD
2 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 HRS
15 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 matters
Bas 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

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.
p. Accident Sketch :
q. Damages Description :
r. Parties Involved :
No of Driver : Casualties: No of Passengers:
No of Passengers: Casualties: Casualties:
s.
S
P
A
D
J
P
J
P
o
l
i
c
e
S
P
A
D
J
P
J
P
o
l
i
c
e
S
P
A
D
J
P
J
P
o
l
i
c
e
S
P
A
D
J
P
J
P
o
l
i
c
e
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 1826
WVA
2277
OMO
APPENDIX 3
ACCIDENT REPORT - Within 24 hours
Third Party