Building / Site Name:
Did this incident involve another trade?
Name of the trade company:
Wind Speed & Direction:
Post Incident Drug & Alcohol Test Conducted?
Hazard Assessment Completed?
Determine the causes that likely have resulted in the incident.
What actions or recommendations are needed to prevent recurrence?
I hereby certify that all information is accurate and that an actual investigaton was conducted as per company policy.
Worker's Name & Signature: