Workplace Drug and Alcohol Incident Report
WORKPLACE DRUG AND ALCOHOL INCIDENT REPORT
This report form is for incidents related to drug and alcohol use within [Your Company Name]. It's crucial to document such occurrences to ensure workplace safety and compliance with company policies.
Instructions:
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Accuracy: Provide accurate and factual details in each section.
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Confidentiality: This report is confidential and should be shared only with authorized personnel.
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Response and Follow-up: Use this report to inform necessary response actions and preventative strategies.
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Support: For assistance, contact [Your Company's Human Resources or Health and Safety Department].
Submit to: [Designated Department or Individual] at [Your Company Name]. This information will be used for immediate action and policy reinforcement.
Incident Details
|
Section |
Details |
|
Date of Incident |
[Month Day Year] |
|
Time of Incident |
[HH:MM AM/PM] |
|
Location of Incident |
[Workplace Location, e.g., Warehouse, Office] |
|
Type of Incident |
[Drug Use, Alcohol Intoxication, etc.] |
|
Description of Incident |
[Employee [Name] was found in an inebriated state during working hours in the warehouse area. A subsequent search revealed a hidden bottle of alcohol.] |
|
Persons Involved |
[Name - Employee, John Doe - Witness] |
|
Witnesses |
[Names of any witnesses, if applicable] |
Immediate Actions Taken
|
Section |
Details |
|
Initial Response |
[The employee was escorted to a safe area and HR was notified.] |
|
Medical Assistance |
[Name] was evaluated by on-site medical staff for health concerns.] |
|
Incident Documentation |
[Statements were taken from [Name] and witnesses.] |
Follow-Up Actions Recommended
|
Section |
Details |
|
Disciplinary Action |
[Consider appropriate disciplinary measures following company policy.] |
|
Policy Review and Reinforcement |
[Reiterate company policies on drug and alcohol use to all employees.] |
|
Employee Assistance Program |
[Offer support through an Employee Assistance Program (EAP) for substance abuse issues.] |
Report Submission:
Submitted To: ______________________[Name/Department]
Submission Date: ___________________[Month Day Year]
Signature of Reporting Individual: ____________________
