Incident Report Form

We aim to make the production industry safer,  at present there is no organisation or body that tracks and records incidents, accidents or near misses on productions.

We want to change this. Filling out this form after an incident helps our industry keep track of the Health and Safety issues that occur on and off-set, and allows the professionals in our industry to better prepare for what might happen in order to keep people safe.

This incident report form will be kept anonymous

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Are you... *
Please provide a brief description of the incident *
Were there any injuries sustained? *
Was the injured party: *
Which department do you work for? *
Under which department did the incident take place? *
In what region (ie, North America, Europe, Sub-Saharan Africa) did the incident take place? *
(Optional) In which country did the incident take place?
What was the type of production? *
How satisfied were you with the handling of the incident? *
Not very
Very much
How much impact did this have regarding your job? *
Not very
Very much
How much impact did this have on the overall production? *
Not very
Very much
What were your key take aways from this incident? *
In your opinion please rate the impact severity of the incident. *
1 = Insignificant   5 = Very Severe
1
2
3
4
5
N/A
Financial
Production Time Lost
Physical Harm
Psychological Harm
Morale
Legal
Company Reputation
Additional feedback on the incident *
Which departments need improvement in response to this incident? *
No improvement needed
Some improvment needed
Lots of improvement
Drastic improvement needed
HSE
Security
Construction
Legal
Production Management
Director
Props
Medical
Any overall feedback for the way the incident was dealt with? *
Name (optional)
Submit
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