Information

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Contractors involved.

SECTION I

  • Date and time of incident

  • Nature of the incident (i.e. fall, struck by, caught between, slip/trip)

  • Add media

  • What Happened

  • How / Why did this happen:

  • What is being done to prevent recurrence?

  • Was there any witness(es)? If yes, provide name(s).

  • Add 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.