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Documenting Health and Safety
43
Health and safety incident report form
The incident
Reported by Department
Email Phone Ext
Date of occurrence Time
Exact locaon
Accident
Incident Near miss Violence Ill health Safety
What happened? Report any details that may have contributed to the incident (i.e., poor lighng).
Use addional paper as necessary and aach to form.
Describe the outcome: harm/health eects/damage.
Describe correcve measures taken to address immediate hazards related to incident.
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Look well to this day. Yesterday is but a dream and tomorrow is only a vision. But today well lived makes every yesterday a dream of happiness and every tomorrow a vision of hope. Look well therefore to this day. | Francis Gray