Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Incident Type

  • Health & Safety Risk

  • Severity

Description of Incident

  • Description

  • Incident photos

Actions Taken

  • 1. Actions Notes

  • Date & Time action taken

  • 2. Action Notes

  • Date & Time action taken

  • 3. Action Notes

  • Date & Time action taken

  • 4. Action Notes

  • Date & Time action taken

Escalation Route

  • Does this require to be escalated to Senior Manager

  • Escalate to

Signature

  • StoreCare Field Manager

  • Store Manager/Assistant

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.