Free Foreign Object Incident Report Form Template

Foreign Object Incident Report Form

Please fill out the form with your information below.

Incident Details

Date of Incident

Location of Incident

    Reporting Party Information

    Name

      Position/Role

        Phone number

          Email

            Describe the foreign object involved

              Describe how the foreign object was identified or discovered

                Provide a step-by-step account of the incident

                  Was the foreign object removed or contained?

                  Were medical or safety personnel contacted?

                  Date:

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