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System · 48 documentsPart of Health and Safety Manual

Incident Report Form

Form · FORM-30057

  • Version 4

The Incident Report Form documents any workplace event that may result in injury or damage: injuries and accidents, near misses, property or equipment damage, and environmental, quality or IT incidents.

It records the incident's details and type, whether it is notifiable and how the regulator was told, what happened, the people involved and the witnesses, the actions taken, any injury or illness, property damage and the incident's impact, and who reported it.

A section for official use lets the supervisor or safety officer classify the incident's severity, assign an investigation, record corrective actions and close it with the lessons learned. It is part of the Health and Safety Manual, whose documents refer to each other.

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Preview of the Incident Report Form

Incident Report Form

FormVersion 4

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What it covers

28 fields

  1. Incident ID
  2. Date of incident
  3. Time of incident
  4. Location of incident
  5. Date of notification
  6. Time of notification
  7. Method of notification
  8. Name of person notified at the regulator
  9. Reference number
  10. Name
  11. Phone
  12. Email

and 16 more

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