construction-incident-report-template.xlsx

	A	G
1	CONSTRUCTION INCIDENT REPORT
2
3	INCIDENT CONTROL & PROJECT DETAILS
4	Incident number	Revision number
5	Status	Confidentiality
6	Project name	Project number
7	Incident date	Incident time
8	Exact location	Reported by
9	Reported to	Report date
10	INCIDENT CLASSIFICATION
11	Incident type	Incident category
12	Event severity	Potential severity
13	High potential	Recordable review
14	Near miss	Work stoppage
15	PEOPLE INVOLVED
16	Primary person involved	Company / employer
17	Role in incident	Injured party
18	Witness summary
19
20	EVENT DESCRIPTION
21	Event description
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23	Activity immediately before event	Observed unsafe condition / act
24	IMMEDIATE RESPONSE
25	Work stopped	Area secured
26	Emergency services contacted	First aid provided
27	Equipment isolated	Scene preserved
28	Immediate response narrative
29	INJURY, DAMAGE & ENVIRONMENTAL SUMMARY
30	Injury / medical summary
31
32	Environmental summary
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34	INVESTIGATION & CONTRIBUTING FACTORS
35	Investigation lead	Investigation start date
36	Investigation completion date	Root-cause approval status
37	Root-cause statement
38
39	CORRECTIVE ACTIONS
40	Immediate corrective actions
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42	Verification / effectiveness review
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44	NOTIFICATIONS, REFERENCES & APPROVAL
45	Notification summary
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47	Prepared by	Safety reviewer
48	Management reviewer
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50	Approval date	Closure date
51	Closure notes
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