Free HR Incident Report Template
HR Incident Report
I. Incident Overview
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Date of Incident: May 15, 2050
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Time of Incident: 10:30 AM
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Location: [Your Company Address]
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Incident Report Number: HRIR-2024-0515
II. Employee Information
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Name: [Employee's Name]
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Employee ID: 123456
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Job Title: Machine Operator
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Department: Production
III. Injury Details
Nature of Injury: Laceration to left forearm, requiring stitches
IV. Description of Incident
While operating machinery, [Employee's Name]'s left forearm came into contact with a sharp edge, resulting in a deep laceration.
V. Immediate Actions Taken
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First aid was administered by the onsite nurse.
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The production supervisor was notified immediately and secured the area.
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[Employee's Name] was transported to the nearby clinic for further medical evaluation and treatment.
VI. Medical Treatment
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Medical Provider: City Clinic
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Treatment Provided: John received stitches and was prescribed antibiotics for the wound.
VII. Safety Recommendations
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Implement additional safety protocols regarding the use of protective gear, especially gloves, during machine operation.
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Conduct a thorough review of machinery to ensure all safety guards are in place and functional.
VIII. Supervisor's Comments
The incident occurred due to a momentary lapse in attention. We will reinforce safety training for all operators.
IX. HR Coordinator's Remarks
Follow-up meeting scheduled with [Employee's Name] to discuss return-to-work arrangements and any needed support.
Submitted By:
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Name: [Your Name]
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Position: HR Coordinator
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Date: May 16, 2050
Approved By:
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Name: [Production Manager Name]
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Position: Production Manager
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Date: May 17, 2050
