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Incident Report Template 02

This document is an incident report form used to report incidents or near misses at work. It collects details of the incident, any injuries or property damage, the cause, planned corrective actions, and space for management comments and signature.

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226 views2 pages

Incident Report Template 02

This document is an incident report form used to report incidents or near misses at work. It collects details of the incident, any injuries or property damage, the cause, planned corrective actions, and space for management comments and signature.

Uploaded by

SOPHY
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Incident report form

Job: ____________________________Date of incident: ___/____/___Time _____am/pm

1. What was the Incident/near miss?

2. Where there any injuries? (Note: Any injuries require an Accident Report Form)

3. Was there any damage to property or plant?


Incident report form

4. What caused the incident?

5. What actions will be taken to eliminate future repeats of the incident?

6. Management comments

Signed off by management when corrective actions have been adopted and monitored.

Management signature_______________________ Date of sign off_________________

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