Title Page

INCIDENT INFORMATION

  • Today's Date:

  • Location of incident:

JOB INFORMATION

  • Job Name:

  • Job Number:

  • Foreman Name:

  • Foreman Phone Number:

ACCIDENT INVESTIGATION

  • Describe the Incident:

  • What caused the incident?

  • What corrective action is being taken to prevent this type of incident from reoccurring?

  • Comments:

SIGNATURES

  • Supervisor Signature:

  • Reviewed By:

PICTURES

  • Please provide pictures of incident scene. Attach additional pictures to email.

  • Picture 1:

  • Picture 2:

  • Picture 3:

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.