Please complete this form after any and all safety related incidents.
Location of incident
Meeting (Lone Star EMI)
What is the Nature of the Incident
What did you observe?
Describe the incident and be specific
What did you do to fix it?
How would you rate the severity? or the possible severity
2. Minor scrape, splinter, or sprain
3. Minor cut/ burn
4. Slip, trip, or fall
5. Professional attention needed
What could be done to prevent this incident in the future?
Who did you report this incident to?
Who is the nearest safety officer?
Page 1 of 1
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service