1. Safesite Solutions, Inc. disclaims all liability (except for any liability which by law cannot be excluded) for any error, inaccuracy, or omission from the information contained in the resources hosted on this website and any loss or damage suffered by any person directly or indirectly through relying on this information. After completing your report in Safesite, you may immediately alert key personnel, tag other users, and create follow-up safety actions. So the more details you have on your report, the less you have to depend on your memory and the more credible you are. If your incident forms are easy to fill out in the field, you’re more likely to capture accurate, timely information. It’s important to include the above information in as detailed and concise a manner as possible. This covers the staff, students, contractors, and visitors. Nevertheless, it is vital and relevant to ensure that the investigation is conducted without bias. If you have to include statements from a witness or other people, you must clarify that you are quoting someone, and the words you used are not your own. John will be out of work for a number of weeks. Since they are easy to use and don’t require skills, their significance and usefulness cannot be denied. This form is applicable for incidents such as violence (physical and verbal), accidents or natural illnesses occurring on university owned or managed premises. John said he felt a bit dizzy when he lost his balance and that he just ‘tripped over his feet.’ He tried to minimize damage to the load itself while falling, which may have led to a more awkward fall. Report and store the files according to your regulator’s requirements. With Safesite, you can create hazards from within an incident report. 3. By continuing to visit this site you agree to our use of cookies. (patient).". As you can see, including the full story, complete with small details and witness statements will help you investigate and recall the incident with greater clarity. Safesite’s incident report form can be filled out on-site via iOS or Android app. No special skills are needed to fill the form which is a point to be noted and appreciated. The root cause is believed to be the unavailability of a hand truck or pallet jack. Irresponsible reporting can lead your team into even more danger, while detailed, clear reporting can lead to improved work conditions and better training. On the way, he complained of blurred vision briefly but said that it had cleared up upon walking into the ER. From tagging and removing damaged equipment from service to safely dismantling corrupted structures, your incident reporting process is not truly complete until you resolve the danger. Safety Inspections, Audits and Checklists, Safety Health and Team Performance Monitoring, Assistance with Digitizing your Safety Documents, Smart Safety Notifications and Safety Campaigns, Available in Spanish and English languages, Library of Inspections, Checklists, and Meeting Templates, How to Implement Your Safety Management System, 3 Tough Personalities at Toolbox Talks & How to Engage Them, JRCRUZ Reduces OSHA Citations + LTRIR to Zero with Safesite, Addiction, Mental Health, and Wellbeing at Work Resource Guide, Manage COVID-19 Risk with Safety Management Software, Top 10 Construction Safety Checklists in 2020 (with Templates), 3 Proven Ways to Achieve Speed and Safety in Project Schedules, Top Certifications for Safety Professionals, The Best Forklift Inspection Checklists – with Free Templates, Type of incident (injury, near miss, property damage, or theft), A narrative description of the incident, including the sequence of events and results of the incident, Video and/or 360-degree photographs of the scene, Description of the incident, including specific job site location, the sequence of events, and the results of the event, Associated hazards raised and resolved following the event, The affected individual’s version of the events, Actions taken by concerned individuals after the incident, How the decision was made to call (or not to call) emergency services, Description of the incident, including specific job site location, sequence of events, and results of the event, Name of the chemical/pathogen/carcinogen, amount, concentration, and description of hazard labels/safety data sheets (SDS), Whether or not a contaminated sharp was involved, Description of injuries, including body part(s) exposed, length of exposure, and size of area exposed, Photographs of the scene and hazard labels involved. For example, instead of writing "the old patient", it is more accurate to describe him as "the 76-year old male patient". Use them as guides to effectively describe events. How many details to include may depend on their relevance to the incident and the policies of your department. Before we show you an incident report sample, let's first study the characteristics of an effective incident report and how to write it. Review federal OSHA incident reporting and recordkeeping requirements or visit your state OSHA website for details. Simple Incident Report Form Incident Report Sample - 9+ Free Documents in Word, PDF. For example, the ladder capacity is 250 lbs and the victim was hoisting 300 lbs. When John fell, his colleagues rushed to his assistance. It is easy to go on a witch hunt when accidents happen. It's a clear report if different people read the same report and come up with similar interpretations. Sometimes people tend to talk about their opinions and beliefs, rather than stating the facts. Incident reports aren’t created for the purpose of finding out who’s to blame. Improve your incident reporting process by using a digital reporting tool, like Safesite, that integrates alerts and hazard resolution. However, confidential details must not be made public, such as a patient's personal information, which must be written somewhere safe. In fact, doing so can needlessly elevate your incident rate. The use of abbreviations may be appropriate in certain cases, such as the use of Dr. Brown and Mr. Green, instead of writing Doctor or Mister. How a report is organized depends on the complexity of the incident and the type of report being written. It covers all aspects of the incident, the extent of the injury, damage to property and corrective measures recommended. While staff should be held responsible (as stipulated by company policy) when they knowingly endanger themselves others, the report should focus on improving workplace safety. During unloading, Lee suddenly experienced lightheadedness and nausea. Including the following details will make your exposure incident report more effective: Here’s an incident report sample description for overexposure via inhalation: “Josh Lee, a freight handler in XYZ Shipping Lines, was exposed to carbon monoxide fumes on December 2, 2017, Tuesday, from (estimated) 7:30 AM to 11:30 AM. Sample Formal Reports are designed specifically for convenience. It includes places to record the details of the event, images of the scene, and witness statements. Instead of waiting, John attempted carrying the load himself. Here are some of the vital elements to include in your description of the incident: Though the details above seem like a lot, mentioning them in the incident report paints a more accurate picture than glossing over the incident. Therefore, to be prepared for such eventualities, it is advisable to have a system which documents all details, ensuring a particular insulation legally. Memory usage: 2226.16KB. She ran a sensor (Portable Direct Reading Monitor) and discovered that CO levels were on the high end but within the acceptable limit: 30 PPM. The various classifications in the forms do provide critical information to the investigating team and can prove precious in their assessment. This is exactly why every single establishment tries to make sure that every precaution is taken so that no future incidents may occur.However, almost every establishment has had at least one kind of incident …

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