Workplace Incident Follow-up Form
WORKPLACE INCIDENT FOLLOW-UP FORM
Please complete the form with accurate and detailed information to ensure a comprehensive follow-up process.
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Incident Details |
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Incident ID: |
[IR-001-1205) |
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Date and Time: |
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Location: |
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Incident Type: |
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Description: |
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Employee Information |
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Employee ID: |
[14-229076] |
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Name: |
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Department and Job Title: |
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Contact Details: |
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Witness Information |
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Name: |
[Name] |
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Email: |
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Phone: |
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Incident Description |
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Incident Details: |
The incident occurred when [Name] slipped on a wet floor in the breakroom. |
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Supporting Evidence: |
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Investigation Report |
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Investigator: |
[Your Name] |
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Contact Details: |
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Date of Investigation: |
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Findings: |
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Immediate Actions Taken |
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Action Taken: |
Immediate cleanup of the spill and placement of warning signs. |
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Responsible Party: |
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Completion Date: |
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Preventive Measures |
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Proposed Measures: |
Implement regular safety training sessions. |
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Responsible Party: |
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Target Completion: |
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Follow-up and Monitoring |
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Follow-up Plan |
Conduct quarterly safety drills. |
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Responsible Party |
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Follow-up Completion |
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Additional Notes
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Cameras on the incident location were not working properly. |
Thank you for your attention to detail in completing this form. Your contributions are vital in maintaining a safe and secure work environment here at [Your Company Name].
For any additional information or queries, please contact [Your Company Number] or email at [Your Company Email].
