Get Electric Shock Report Form - Word Doc - Infrastructure

The Electric Shock Report Form is essential for documenting incidents involving electric shocks and ensuring proper investigation and reporting. This guide will help you navigate the process of completing this important form online, ensuring all necessary information is provided accurately.

Follow the steps to complete the Electric Shock Report Form effectively.

1. Click 'Get Form' button to obtain the form and open it in your chosen editor.
2. Fill out the 'Victim' section. Start by entering the name of the person who experienced the electric shock, followed by their address, occupation, and phone number. It's also important to document any injuries received.
3. Complete the 'Incident Site' section. Provide the occupier's name and address of the site where the incident occurred. Include relevant contact details, the incident date, and who reported it to the electricity service provider (ETSA) and the Office of the Technical Regulator (OTR).
4. In the 'Incident Details' section, detail the location of the incident and describe how the shock was received. Make sure to specify the objects that conducted the current as well as the entry and exit points on the victim's body.
5. Document the 'Test Results' by noting the voltage measured at the time of arrival and after any remedial actions. Also include the system voltage and the type of test instruments used.
6. List any products or equipment involved in the incident, including their trade names, models, and any relevant approval numbers and insulation resistance measurements.
7. Identify the cause of the incident in the 'Investigation' section. Note any actions taken to ensure safety and include the name and details of the investigators.
8. Answer all follow-up questions related to the incident thoroughly. This section will cover various aspects like the responsibility of the injured person, safety protocols, and any previous incidents.
9. After filling out the form, review all information for accuracy and completeness. Ensure that all necessary signatures are included where required.
10. Finally, save the changes made to the form. You can then download, print, or share the completed form as needed.

Complete and submit the Electric Shock Report Form online to ensure compliance with safety regulations.