The Critical Incident Report Form is a mandatory document required under Indonesian workplace safety regulations for recording and reporting significant workplace incidents, accidents, or near-misses. It must be completed within the timeframes specified by Minister of Manpower Regulation No. 03 of 1998 and maintained in accordance with Law No. 1 of 1970 on Work Safety. The form serves multiple purposes: regulatory compliance, incident investigation, risk management, insurance claims processing, and continuous improvement of safety measures. It contains detailed information about the incident, including circumstances, responses, affected parties, and initial corrective actions. This document is crucial for organizations operating in Indonesia to demonstrate compliance with workplace safety requirements and maintain proper incident documentation.
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1. Incident Identifier: Unique reference number, date, time, and location of the incident
2. Reporter Information: Details of the person completing the report including name, position, contact information
3. Incident Classification: Category and severity level of the incident according to standard classification criteria
4. Incident Details: Detailed description of what happened, including sequence of events and immediate actions taken
5. Persons Involved: Information about all individuals involved, including witnesses, affected parties, and responders
6. Impact Assessment: Description of injuries, property damage, operational disruption, or other consequences
7. Initial Response: Actions taken immediately following the incident, including emergency responses and notifications
8. Root Cause Analysis: Initial assessment of factors contributing to the incident
9. Immediate Corrective Actions: Steps taken to address immediate risks and prevent recurrence
10. Reporting Compliance: Confirmation of notifications to required authorities as per Indonesian regulations
1. Environmental Impact: Assessment of environmental consequences - required for incidents involving environmental hazards
2. Media and Communications: Communication plan and media statements - needed for high-profile incidents
3. Financial Impact: Preliminary cost assessment - required for incidents with significant financial implications
4. Third Party Involvement: Details of contractors or external parties - needed when non-company personnel are involved
5. Business Continuity Measures: Actions taken to maintain operations - required for incidents affecting business operations
1. Incident Scene Photographs: Visual documentation of the incident scene and damage
2. Witness Statements: Written accounts from witnesses and involved parties
3. Medical Reports: Copies of relevant medical documentation if injuries occurred
4. Equipment/Property Damage Report: Detailed assessment of physical damage to assets
5. Investigation Timeline: Chronological sequence of events and investigation activities
6. Regulatory Notification Records: Copies of mandatory reports submitted to authorities
7. Risk Assessment Matrix: Standard risk assessment form showing incident severity and likelihood ratings
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