Incident Report

• Document No.

• Prepared by

• Location
  Address

• Site:
  Address

• Date reported:

  Date

• Person who reported the incident to Mega Homes:

• Date & time incident occurred:

  Date

• Brief description of the incident:

• Type of incident

  Injury

  Near Miss

  Property/Equipment

Details of the injured person

• Name:

• Date of Birth:

  Date

• Contact number

• Employer:

Incident Details

• Full details of the incident:

• Immediate actions taken: