Title Page

  • Please follow the accident incident reporting flowchart

  • Project:

  • Operations Manager

  • Classification

  • Date and time of event

  • Location of incident

  • Description of event:

  • Immediate actions taken

  • Details of injury/damage/security implications

Person(s) involved

  • Person(s) involved

  • Occupation

  • Employer

  • Supervisor

  • Distribution Please confirm all of the below have been notified by checking the boxes

  • Photographic evidence:

  • Person completing form

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.