• Exposure #:

  • Case #:

  • Site

  • Conducted on

  • Prepared by:

  • Sign:

  • Exposure Follow up Completed:

Exposure Details:

  • Date of Incident:

  • Department where incident occured:

  • Individual:

  • Source:

  • Nature:

  • Presented for treatment:

  • Date Reported:

  • Reported To:

  • Type of Device/Equipment:

  • Brand Name of Device/Equipment:

  • Location of Incident:

Describe What Happened

  • Enter Discription:

  • Was any equipment involved?

  • Pertinent Photos:

What action was taken immediately after the incident?

  • Enter description

Can any improvements be made as a result of this occurrence?

  • Details

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.