ILSC-Toronto Health and safety incident report form
Please fill in as much detail to document the incident. [Version 1.0]
Main information
Reported by *
Name
Your answer
Department *
Email *
Your answer
Phone (optional)
Your answer
Date of occurrence *
MM
/
DD
/
YYYY
Time of occurrence/incident
(if known)
Time
:
Location of occurrence *
CAMPUS
Type of occurrence *
Location of occurrence *
ROOM NUMBER, etc. (or other, e.g. corridor outside 2nd-floor staff washroom)
Your answer
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