Incident Flash Report

• Insert Project and Brief Incident Description

• Date/Time of Incident

  Date

• Prepared by

• Document No.

Details of the Incident

• Description of the Incident:

• Location:

• Name/s of persons involved:

• Staff dealing with incident:

• Staff attending incident site:

• Responsible Supervisor/Manager:

Immediate Action Taken

• Provide details of any corrective action taken at the time of this report:

Incident Type

• Safety and Health

• Environment

• Community

• Non-SHE

• Fatality/s

• Lost Time Injury / Taken to Hospital

• Medical Treatment Injury

• First Aid Injury

• Near Miss

• Property Damage

• Security Breach

• Hazard

• Procedural Breach

• Other

• Other description

Drug and Alcohol Testing

• Drug and alcohol testing undertaken?

  Yes

  No

  N/A

• Breath test returned?

  Negative

  Non-negative

  N/A

• Urine test returned?

  Negative

  Non-negative

  N/A

• Awaiting arrival of tester?

  Yes

  No

  N/A

Incident Classification

• Class 1

• Level 1

• Class 2

• Level 2

• EPC1

• PC1

Sign off

• Name

• Signature

  Sign

• Phone number