Incident Report form
- Incident Report Number – Unique number for tracking each IRF# & Date
- Environmental Incident / Health and safety incident – Description of the accident / incident happen in industry that need to short description. For the primary understanding for the first view presentation is much important to go for quick analysis mode.
- Department / Branch/ and exact place(Division) where the ACCIDENT or the dangerous occurrence happened – Information of the incident happen in the area and its actual location mention is very important for the investigate.
- Date, hour, shift of Accident or Dangerous occurrence – information of the actual time of incident.
- Name of Person who injured / Occupation / working at place / Machine / equipment
- Injury on body part
- Type of Injury – Near Miss / Minor Injury / Fetal
- First Aid Details – Whether first aid given
- Facts Behind – Incident information, investigation and reporting information analysis for the finding facts behind incident happen.
- Root Cause – Real Reason behind incident to easier to eliminate, minimize risk level in company.
- Corrective / Preventive action to avoid such type of Accident / Incident in future.
EXAMPLES, SAMPLES & FORMATS
You would also like to read: