Scribd
Upload
26 views1 page

? Incident Report

The document is an incident report template that outlines essential details to be filled out following an incident. It includes sections for incident specifics such as date, time, location, individuals involved, type of incident, and actions taken. Additionally, it emphasizes the importance of root cause analysis and corrective actions to prevent future occurrences.

Uploaded by

munam hse
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
26 views1 page

? Incident Report

The document is an incident report template that outlines essential details to be filled out following an incident. It includes sections for incident specifics such as date, time, location, individuals involved, type of incident, and actions taken. Additionally, it emphasizes the importance of root cause analysis and corrective actions to prevent future occurrences.

Uploaded by

munam hse
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
You are on page 1/ 1

📝 Incident Report – Table Format

Section Details
Report ID IR-2025-###
Date of Incident [DD/MM/YYYY]
Time of Incident [HH:MM AM/PM]
Location [Specific site/location of incident]
Reported By [Name, Designation]
Designation [E.g., Site Engineer, Safety Officer]
Department [E.g., Construction, Maintenance]
Injured Person(s) [Full name(s), Employee ID, Designation]
Witness(es) [Names and contact info of any eyewitnesses]
Incident Type [e.g., Slip/Trip/Fall, Equipment Failure, Fire, Chemical Exposure]
Severity Level [Minor / Major / Critical / Near Miss]
Description of Incident [Brief narrative of what happened – include sequence of events]
Immediate Action
[First aid given, area secured, equipment shut down, etc.]
Taken
Injuries Sustained [Type and extent of injuries, if any]
Damage to Property [Details of any damage to tools, equipment, or facilities]
Root Cause [E.g., Human error, Mechanical failure, Procedural lapse]
[Steps taken to prevent recurrence, responsible person, target
Corrective Actions
completion]
Follow-up Required [Training, PPE check, policy review, engineering controls, etc.]
Reported to [Name & Position – Supervisor, HSE Manager]
Date Reported [DD/MM/YYYY]
HSE Officer’s
[Name & Signature]
Signature
Supervisor's Comments [Review and remarks from site supervisor]
Final Approval By [HSE Manager or Safety Head Name & Signature]

You might also like