Incident Report Form

 

 

INCIDENT REPORT FORM

  • To be completed in the event of a worker witnessing/being involved in any non-conformance, or an incident, or resulting, or potentially resulting, in an injury or an unsafe practice or a near hit.
  • Personal details:















  • Incident details

    completed by person involved




  • :



  • Name of witnesses to the incident







  • Details of injuries sustained

  • Details of other persons involved

  • Details of any damage

  • Other details

  • What did we do at the time of the incident?

  • Corrective actions

  • Consultation

    Who did we consult with when deciding on the actions for the controls?