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Form 15 NOTE: i) ii) EMPLOYEE S REPORT OF INJURY/ILLNESS ALL ACCIDENTS MUST BE REPORTED TO YOUR SUPERVISOR IMMEDIATELY THIS PERSONAL INJURY REPORT IS TO BE COMPLETED BY THE INJURED EMPLOYEE (OR DESIGNATE).

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Type of incident (injury, near miss, property damage, or theft) Address. Date of incident. Time of incident. Name of affected individual. A narrative description of the incident, including the sequence of events and results of the incident.

Incident Description. Date / Time / Location. Details of injuries / Damage to equipment / Environmental impact / Impact on production or operations. Risk rating (actual and potential consequence) Photographs. Timeline / Sequence of events.

An incident report is a form to document all workplace illnesses, injuries, near misses and accidents. An incident report should be completed at the time an incident occurs no matter how minor an injury is.

Type of incident (injury, near miss, property damage, or theft) Address. Date of incident. Time of incident. Name of affected individual. A narrative description of the incident, including the sequence of events and results of the incident.

Date, time, location of the incident. The extent of the damage done. Names and designations of the people involved. Names and claims of witnesses. Series of events leading up to the incident. Environmental conditions during the time. Specific injuries sustained by people.

Write objectively. Describe exactly what you saw. ... Incorporate patient and witness accounts of the event into the report. ... Don't assign blame. ... Avoid hearsay and assumptions. ... Forward the report to the person designated by your facility's policy.

Write objectively. Describe exactly what you saw. ... Incorporate patient and witness accounts of the event into the report. ... Don't assign blame. ... Avoid hearsay and assumptions. ... Forward the report to the person designated by your facility's policy.

The definition of an incident is something that happens, possibly as a result of something else. An example of incident is seeing a butterfly while taking a walk. An example of incident is someone going to jail after being arrested for shoplifting. An event in a narrative or drama.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232