Construction Incident Report Form
Construction Incident Report Form
Please fill out this form thoroughly to report any incidents that occurred on the construction site.
Basic Information
Reporter Name
Phone Number
Date and Time of Incident
Location of Incident
Describe the Incident
Provide a detailed account of what happened, including the events leading up to the incident.
Type of Incident
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Injury
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Property Damage
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Near Miss
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Equipment Malfunction
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Injured Person(s) (if applicable)
Name(s) of Injured
Description of the Injury
Describe the injury and location on the body.
Immediate Action Taken
Describe any steps taken immediately after the incident, such as first aid, equipment shut-down, etc.
Was Medical Attention Required?
If yes, where and when?
Provide details here.
Supervisor Notified
Supervisor Name
Corrective Action to Prevent Future Incidents
Describe what will be done to prevent a recurrence.
Additional Comments
Provide any additional information relevant to the incident.
Signature
Name:
Date:
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