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Online Accident or Incident Report
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What happened? (Full description).
Your answer
How did it happen? Step by step.
Your answer
Where were you working?
Your answer
When did this happen?
MM
/
DD
/
YYYY
Has it happened before?
Yes
No
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How frequently has it happened before?
Weekly
Monthly
Yearly
Less frequently
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Is there any documentation, photos or evidence?
Your answer
Did it breach company policy?
Yes
No
Other:
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Have you raised this with anyone?
Yes
No
Name:
Other:
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Has anyone been harmed by this?
Yes
No
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Is anyone still in danger from it?
Yes
No
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