INCIDENT STATEMENT

I. INTRODUCTION

In the dynamic landscape of Safety Management in Construction, incident reporting stands as a cornerstone for maintaining safety, integrity, and accountability. This statement template serves as a guide for individuals and organizations to meticulously document factual details, observations, and actions on specific incidents, accidents, or emergencies. By adhering to this structured approach, we ensure the accuracy, completeness, and consistency crucial for effective incident reporting, facilitating subsequent analysis, investigation, and legal proceedings.

II. INCIDENT DETAILS

A. Incident Identification
Date and Time: April 24, 2050 - 10:30 AM
Location:	Construction Site, [City], [Country]
Nature of Incident:	Fall from Height

 

B. Witness Information
Name:	[Your Name]
Contact Information	[Your Company Number]
Statement: "I saw the worker lose his balance and fall from the scaffolding."

C. Involved Parties:
Name:	[Involved Party's Name]
Contact Information	[Involved Party's Number]
Role:	Construction Worker
Injuries/Impact: Fractured arm, transported to [Hospital Name] for treatment.

III. OBSERVATIONS AND FINDINGS

A. Sequence of Events: Detailed chronological order of events leading to the incident. The worker climbed scaffolding to perform maintenance. The worker lost balance and fell approximately 15 feet to the ground. Colleagues rushed to provide first aid and called emergency services.

B. Environmental Factors: Weather Conditions: Clear skies, moderate wind. Lighting Conditions: Adequate natural light. Surrounding Hazards: Uneven terrain, presence of construction materials.

C. Equipment and Resources Involved: Description: Steel scaffolding, safety harness. Condition: Scaffolding inspected before use, safety harness in good condition. Maintenance Records: Regular inspections logged, last inspection conducted on April 20, 2050.

IV. ACTION TAKEN

A. Immediate Response:

• Initial Actions: Colleagues administered first aid, and secured the area.

• Emergency Services Notified: Emergency services contacted immediately, and arrived on-site within 10 minutes.

• First Aid/Administration: Worker stabilized and transported to [Hospital Name] for further treatment.

B. Documentation and Communication:

• Incident Report Filed: An incident report was filed by the site supervisor, [Supervisor's Name].

• Notifications: The project manager, safety officer, and relevant authorities were notified.

• Internal Communication: The incident was communicated to all workers via safety meetings and email bulletin.

C. Mitigation Measures:

• Preventive Measures: Height safety training was reinforced, and additional safety measures were implemented for working at heights.

• Safety Protocols Review: Review of scaffolding usage protocols scheduled for all construction team members.

• Training Needs Identified: Identified need for refresher training on fall protection equipment and emergency response procedures.

V. CONCLUSION

In conclusion, the meticulous documentation of incident details, observations, and actions is paramount in fostering a culture of safety and accountability within ABC Construction Company. By utilizing this statement template, we reinforce our commitment to transparency, continuous improvement, and the well-being of all individuals involved. Together, we strive towards minimizing risks, enhancing operational resilience, and achieving our collective goals in Safety Management in Construction.

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