Title Page
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Conducted on
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Prepared by
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Line manager
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Location
Details
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Location of incident
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Who was involved?
- Employee
- Public
- Contractor
- Visitor
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Name of person involved
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contact details of person involved
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Brief description (what happened?)
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Photos (i.e., equipment, vehicles, etc.)
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What steps can be taken to avoid this in the future?
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Signature of person reporting
Investigating manager only
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Investigating manager (if applicable)
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Date
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Outcome
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lessons learned
