Workplace Incident Reporting Agreement
WORKPLACE INCIDENT REPORTING AGREEMENT
This Workplace Incident Reporting Agreement (hereinafter referred to as the "Agreement") is entered into and made effective as of [Month Day Year]. This Agreement is by and between the following parties:
[Your Company Name], a [specify type of entity, e.g., corporation, LLC, etc.] duly organized and existing under the laws of [specify jurisdiction], with its principal place of business located at [Your Company Address] (hereinafter referred to as the "Company").
AND
[Your Name], an individual currently employed by the Company in the capacity of [specify job title or role], with contact information as follows: personal email [Your Email Address], user phone [Your User Phone] (hereinafter referred to as the "Employee").
WHEREAS, the Company is engaged in [brief description of the Company's business and operations] and recognizes the importance of maintaining a safe and secure work environment for all its employees, clients, and stakeholders;
WHEREAS, the Employee is currently employed by the Company and acknowledges the necessity of adhering to the Company’s policies and procedures, especially concerning the reporting of any incidents that occur within the workplace;
NOW, THEREFORE, in consideration of the mutual covenants contained herein and for other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the Company and the Employee (collectively referred to as the "Parties") agree to the terms and conditions outlined in this Agreement as follows:
I. Purpose of Agreement
a) The primary purpose of this Agreement is to establish a clear and effective procedure for the reporting of workplace incidents by the Employee to the Company. This ensures the safety, security, and well-being of all employees and the workplace environment.
b) The Employee agrees to report any incidents that occur in the workplace, including but not limited to accidents, injuries, safety hazards, security threats, or any other occurrences that could potentially harm employees, clients, or the Company's operations.
II. Incident Reporting Procedure
a) In the event of an incident, the Employee shall immediately report the incident to the Company's designated representative via [Your Company Email] or [Your Company Phone Number]. The report should include a detailed description of the incident, the time and location of its occurrence, and any other relevant information.
b) The Employee is required to complete a formal Incident Report Form, available on [Your Company Website] or from the Company's Human Resources Department. This form must be submitted within 24 hours of the incident occurrence.
III. Confidentiality and Non-Disclosure
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The Employee agrees to maintain the confidentiality of all information related to workplace incidents and shall not disclose such information to any third parties without the express written consent of the Company.
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Any breach of confidentiality may result in disciplinary action up to and including termination of employment and legal action for damages caused to the Company.
IV. Compensation and Liabilities
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In cases where the Employee is injured during the incident and the incident is directly related to the Employee's job duties, the Company agrees to compensate the Employee an amount not exceeding [$000.00], subject to the Company’s discretion and applicable laws.
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The Company shall not be liable for any incident that occurs due to the Employee's negligence or failure to adhere to Company policies and safety protocols.
V. Amendments and Governing Law
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This Agreement may only be amended in writing and signed by both the Company and the Employee. Oral agreements or modifications are not considered valid.
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This Agreement shall be governed by and construed by the laws of the jurisdiction in which [Your Company Name] operates.
IN WITNESS WHEREOF, the parties have executed this Workplace Incident Reporting Agreement as of the date first above written.
[Your Company Name]
By: __________________________________
Name:
Title:
Employee
By: __________________________________
Name: [Your Name]
Date: [Month Day Year]
