GPS location


Building/ Floor / Room

Type of incident (select all that apply)

Enter type

Incident details

Take photo evidence of incident

Problems identified

List all persons involved in the incident

Did fire brigade attend?

Sign Off
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.