First Incident Details

  • Date & Time of Incident

  • Location of Incident
  • Incident Priority?

  • Incident Type?

  • Please describe type of incident

  • Name of team leader at time of incident

  • Is immediate medical attention required?

  • What kind of medical attention was administered?

Describe What Happened

  • Describe what happened. Please be detailed but state only facts.

  • What were the weather / environmental conditions at the time of the incident?

  • Describe the weather / environmental conditions at the time of the incident

Record Evidence and Information

  • Which of the following do you need to attach to this report to accuractly document this incident?

Evidence Log

  • Please log all relevant evidence below

  • Evidence
  • Evidence Description

  • Evidence ID number (if applicable)

  • Type of evidence

  • Photos of evidence (if applicable)

  • Please detail any further information regarding this evidence (if applicable)

Vehicle Log

  • Please log all relevant vehicle details below

  • Vehicle
  • Vehicle Make

  • Vehicle Model

  • Vehicle Rego

  • Driver (if applicable)

  • Photos of equipment (if applicable)

  • Please detail any further information regarding this vehicle (if applicable)

Damage Log

  • Please log all relevant damage details below

  • Damage
  • Damage description

  • Photos of damage (if applicable)

  • Please detail any further information regarding this damage (if applicable)

Other Items Log

  • Please log all relevant details of other items below

  • Item
  • Item description

  • ID number (if applicable)

  • Photos of item (if applicable)

  • Please detail any further information regarding this item (if applicable)

Equipment Log

  • Please log all relevant equipment details below

  • Equipment
  • Equipment Make

  • Equipment Model

  • Equipment ID number (if applicable)

  • Photos of equipment (if applicable)

  • Please detail any further information regarding this equipment (if applicable)

People involved

  • Please document all people involved in this incident, including yourself (the person reporting the incident)

  • Person

Person

  • Full Name

  • Contact phone number

  • What is this person's relation to the incident? (select all that apply)

  • Describe this person's relation to the incident

  • Please describe this person's involvement with the incident, including all relevant information

  • Does this person wish to make a preliminary statement?

Preliminary Statement

  • Statement regarding incident

  • Person Signature

  • Has this person sustained an injury?

Injury Details

  • Type of injury or illness? (select all that apply)

  • Describe type of injury or illness

  • Parts of body affected? (select all that apply)

  • Please describe injury location

  • Describe this injury or illness

  • What was the cause of this injury or illness?

Corrective Actions

  • Are corrective/further actions required with regard to this incident?

  • Have all required corrective actions been added as Actions to this inspection?

  • Please add any corrective actions to the appropriate questions above before completing this incident report

Sign Off

  • Further action/follow-up/investigation required?

  • Name of person/people to follow up

  • Name & Signature of Reporter

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