Title Page

  • Conducted on

  • Prepared by

  • Location


  • GPS location
  • Department

  • 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

  • Signature

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.