West Virginia Hazard and Incident Report Form

State:
Multi-State
Control #:
US-435EM
Format:
Word; 
Rich Text
Instant download

Description

This form is used to report all work-related hazards and incidents.

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FAQ

An incident report is a tool that documents any event that may or may not have caused injuries to a person or damage to a company asset. It is used to capture injuries and accidents, near misses, property and equipment damage, health and safety issues, security breaches and misconducts in the worksite.

Importance of incident reporting Thus, the significant benefits of incident reporting include: - It prevents severe accidents when safety issues are identified and fixed before they become more significant problems. - It saves time and resources that could otherwise be spent dealing with more severe accidents.

Keep in mind that these 3 considerations are not to be confused with the 3 requirements for writing an incident report:The report must be factual and without assumption.An incident report must be accurate and without bias.The incident report must be complete.18-Jan-2021

1. Find the FactsDate, time, and specific location of incident.Names, job titles, and department of employees involved and immediate supervisor(s)Names and accounts of witnesses.Events leading up to incident.Exactly what employee was doing at the moment of the accident.More items...

How to Write a Workplace Incident ReportWorker Information. Collect personal information on everyone who was involved in the incident, even if just as a bystander.Injury/Illness Characteristics.Describe the Working Environment.Equipment Characteristics.Take Photo and Video Evidence.Takeaway.

What must be reported?Deaths and injuries caused by workplace accidents.Occupational diseases.Carcinogens mutagens and biological agents.Specified injuries to workers.Dangerous occurrences.Gas incidents.

When should an incident be reported? All incidents, near-misses and injuries should be reported immediately. The incident reporting process will determine the follow-up required, if any. The employee should not have to make a guess as to whether their issue or incident is worthy of an incident report.

Any other person (not an employee) was injured or became ill as a possible result of actions caused by the company or an employee. an employee was in a motor vehicle accident while driving for their job. a near-miss occurred that could have resulted in injury, death, or property damage.

You should always report these incidents when it affects your operations. Property damage, dangerous situations, and more may occur during a natural disaster incident, and therefore the incident may require more than one type of incident report form.

The purpose of an incident report is to state the cause of the problem along with corrective actions that can be taken to minimise the risk of a future occurrence. The forms can also be used as safety documents, outlining potential safety hazards around the workplace.

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West Virginia Hazard and Incident Report Form