Job Details

  • Job/Incident Number

  • Date incident occurred

  • Location

Engineer Details

  • Engineer

  • Tech Number

  • Team Number

Person completing report

  • Prepared by

  • Date of Team Manager site visit


  • Do we accept liability

Record of findings - (Full details giving reason for denying or accepting liability with photographic evidence including report and clearly stating Liability Accepted/ Denied)

  • We're there any witnesses?

  • Witness details if not the person reporting the incident

Photographs and drawings

  • Add media

  • Add drawing

  • Add drawing

Corrective Action

  • Has the person reported been made adware of the incident

  • Has the Health and Safety department been notified?

  • Is further investigation required?

  • Who will carry out further investigation?

  • Has an incident report been completed on Solars

Actions agreed with customer

  • Customer Signature


  • Manager signature

  • Engineer signature

Email report to

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.