Free Simple Safety Incident Report Form Template
Simple Safety Incident Report Form
Please fill out the form with your information below.
Incident Details
Date and Time of Incident
Location of Incident
Type of Incident
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Injury
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Near Miss
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Property Damage
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Environmental Spill
Description of Incident
Injuries Sustained
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No Injuries
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Minor Injury
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Moderate Injury
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Serious Injury
Injured Party Information
Name
Position
Department
Phone number
Corrective Actions Taken
Root Cause Analysis
Date:
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