Free Safety Violation Incident Report Form Template
Safety Violation Incident Report Form
Please fill out this form completely to document any safety violation.
Date
Incident Location
Reporter's Name
Reporter's Email
Please provide your email address.
Reporter's Phone Number
Role
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Employee
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Supervisor
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Visitor
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Type of Violation
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Failure to Follow Safety Procedures
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Use of Unauthorized Equipment
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Neglect of Personal Protective Equipment (PPE)
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Hazardous Behavior
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Detailed Account of Violation
Provide a clear explanation of what occurred, including the rules or policies violated.
Was there an immediate danger to individuals?
Were any injuries or damages reported?
Immediate Actions Taken
Describe actions taken to address the violation, such as stopping the activity, notifying a supervisor, or providing corrective instructions.
Relevant Files or Documents
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Supervisor |
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