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Incident Investigation and Analysis Report

Steps

  1. 1. Employee Section
  2. 2. Supervisor Section
  • Employee Section

    1. Form needs to be completed within 24 Hours of incident

    2. EMPLOYEE'S REPORT OF INCIDENT

    3. Did employee receive medical attention:*

    4. if no witnesses please type "none"

    5. Was personal protective equipment required for performing this? *

    6. If Yes, was it used?*

    7. If Yes, was it used correctly ?

    8. Entering name constitutes that you have filled out the form to the best of your knowledge