Title Page

  • Time and date of incident

  • Employee's Name

  • Contact number

  • Name of manager notified

  • NG employee or contractor

  • Reported by

  • Responsible department

  • If other please specify

  • Incident address
  • Document No.

  • Brief description of hazard

  • Location of hazard

  • Actions taken

  • Photos

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.