Incident Report Form

Provide us with all incident details through this form.
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The person involved
Please provide us with some basic information about the person involved in the incident.
Full name
Address
Phone number
Were they injured in the incident?
Have they received any medical care?
The incident
Please provide us with all details regarding the incident.
Date (dd/mm/yyyy)
Time (hh:mm)
Location
Describe the incident in detail
Have the police been notified about the incident?
Thank you.
Your report has been submitted.

Incident Report Form Template

Record the details of any workplace incident for insurance and prevention purposes using an incident report form.
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