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Incident Report
Report of Incident (Event details, causes, actions)
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* Indicates required question
Date
*
MM
/
DD
/
YYYY
Year
Your answer
Month
Your answer
Incident number
(BAM22 - ??)
*
Your answer
Type of Incident
*
Choose
Critical Injury/ies
Damage incident
First Aid
Health/Occupational Disease
High potential Incident
Lost Time Injury
Major Hazard Incident
Medical Treatment
Near Miss
Non related Work Incident
Permanent Disability
Restricted Work Case
Other
Name of person(s) involved
Your answer
Shift (Day or Night)
*
Choose
Day
Night
Occupation Involved
Your answer
Coy/Badge No
Your answer
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