Initial Incident Assessment Form

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Incident Details

• Description of the incident

• Incident date and time

  Date

• Photo/s depicting incident location

  Media

• Sketch to further describe incident (if appropriate)

  Drawing

Assessment of Incident

• Were council's assets involved? (If yes, double tap YES to provide details - Tap 'Add Media' to add photos of assets involved)

  Yes

  No

  N/A

• Were council staff operating/carrying out works in the area? (Double tap YES to provide details - Tap 'Add Media' to add photos of works area)

  Yes

  No

  N/A

Sign Off

• Assessing officer's signature

  Sign