Please complete this form to document any incidents that occur in the warehouse.
Specific warehouse area or section
Injury
Equipment Damage
Property Damage
Near Miss
Hazardous Material Spill
Option 6
Provide a detailed account of what happened, including the sequence of events leading up to the incident.
Skip if no injury occurred
Specify body part affected, nature of injury
Minor
Moderate
Major
Name and Position
Name:
Date:
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