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1. Incident Identification Details: Basic information including date, time, location, and reference number of the incident
2. Reporter Information: Details of the person completing the report including name, position, contact information, and relationship to the incident
3. Incident Classification: Category and severity level of the incident based on standardized classification criteria
4. Incident Description: Detailed narrative of what occurred, including sequence of events and immediate impact
5. Persons Involved: Information about all individuals involved, including affected persons, witnesses, and responders
6. Immediate Actions Taken: Description of emergency response actions and immediate steps taken to control or contain the incident
7. Notifications Made: List of all parties notified including emergency services, management, regulatory bodies with timestamps
8. Initial Risk Assessment: Preliminary evaluation of risks and potential consequences
9. Investigation Findings: Initial findings regarding cause and contributing factors
10. Corrective Actions: Immediate and planned corrective actions to prevent recurrence
11. Sign-off Section: Verification and authorization section including relevant signatures and dates
1. Medical Response Details: Detailed information about medical treatment provided, to be included when incident involves injuries or health issues
2. Environmental Impact: Assessment of environmental effects and mitigation measures, required for incidents involving environmental hazards
3. Equipment/Property Damage: Detailed description of damage to equipment or property, included when physical assets are affected
4. Media and Communications: Communication strategy and media handling, required for high-profile incidents
5. Business Continuity Impact: Assessment of impact on business operations, included for incidents affecting operational continuity
6. Regulatory Compliance Section: Additional regulatory reporting requirements, included based on incident type and regulatory obligations
1. Appendix A - Incident Scene Documentation: Photographs, diagrams, or sketches of the incident scene
2. Appendix B - Witness Statements: Detailed statements from witnesses and involved parties
3. Appendix C - Risk Assessment Matrix: Standardized risk assessment tool and completed evaluation
4. Appendix D - Incident Classification Guide: Reference guide for standardized incident classification
5. Appendix E - Emergency Contact List: List of emergency contacts and escalation procedures
6. Appendix F - Supporting Documentation: Relevant certificates, licenses, maintenance records, or other supporting documents
Near Miss
Affected Party
Authorized Person
Competent Person
Corrective Action
Dangerous Occurrence
Emergency Response
First Aid Injury
Hazard
Immediate Action
Incident Scene
Investigation Findings
Lost Time Injury
Material Damage
Medical Treatment Case
Notifiable Incident
Personal Data
Preventive Action
Primary Investigator
Recordable Incident
Regulatory Authority
Reporting Person
Risk Assessment
Root Cause
Safety Officer
Serious Injury
Severity Level
Supporting Documentation
Witness Statement
Workplace
Work-Related Injury
Personal Data Protection
Confidentiality
Reporting Requirements
Emergency Response
Investigation Procedures
Documentation Requirements
Regulatory Compliance
Medical Response
Health and Safety
Witness Statements
Evidence Preservation
Root Cause Analysis
Corrective Actions
Risk Assessment
Authority and Responsibility
Information Disclosure
Legal Obligations
Record Keeping
Data Retention
Environmental Impact
Business Continuity
Insurance Notification
External Communications
Healthcare
Manufacturing
Construction
Transportation
Education
Financial Services
Hospitality
Retail
Logistics
Chemical Industry
Energy
Mining
Maritime
Aviation
Public Services
Telecommunications
Information Technology
Property Management
Health and Safety
Risk Management
Compliance
Operations
Human Resources
Legal
Security
Emergency Response
Quality Assurance
Environmental Health
Facilities Management
Training and Development
Internal Audit
Insurance and Claims
Chief Executive Officer
Chief Operating Officer
Health and Safety Manager
Risk Management Director
Compliance Officer
Facility Manager
Department Supervisor
Security Manager
Environmental Health and Safety Coordinator
Quality Assurance Manager
Operations Manager
Human Resources Director
Emergency Response Coordinator
Workplace Safety Officer
Site Manager
Shift Supervisor
Department Head
Legal Counsel
Insurance Coordinator
Training Manager
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