Incident Report

In the event of an incident, this report will need to be completed as soon as possible and submitted.

Name of worker completing report *

Phone number *

Position *

Details of incident

Date of incident *

Location of incident *

include details

Who was involved?

Name *

Contact details *

Client/worker/witness *

What happened? *

Immediate action taken *

Confirmation of completing employee

I hereby confirm that the information provided in this report is accurate to the best of my knowledge:

Signature of employee *

Clear

Date *