Critical Incident Report Form Template for Indonesia

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Key Requirements PROMPT example:

Critical Incident Report Form

"I need a Critical Incident Report Form for our manufacturing facility in Jakarta that complies with Indonesian regulations and includes specific sections for chemical spills and machinery accidents, as well as integration with our digital reporting system."

Document background

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.

Suggested Sections

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

Optional Sections

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

Suggested Schedules

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

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co

Relevant legal definitions

Clauses

Relevant Industries

Manufacturing

Construction

Mining

Oil and Gas

Healthcare

Transportation

Logistics

Chemical Industry

Agriculture

Forestry

Maritime

Aviation

Retail

Hospitality

Education

Energy

Telecommunications

Food Processing

Pharmaceutical

Relevant Teams

Health and Safety

Operations

Human Resources

Risk Management

Compliance

Security

Emergency Response

Quality Assurance

Environmental Health

Facilities Management

Production

Maintenance

Legal

Internal Audit

Corporate Communications

Relevant Roles

Health and Safety Manager

Operations Manager

Site Supervisor

Facility Manager

Risk Management Officer

Compliance Officer

Department Head

Security Manager

Emergency Response Coordinator

Human Resources Director

Quality Assurance Manager

Plant Manager

Shift Supervisor

Environmental Health Officer

Chief Operating Officer

Safety Inspector

Production Manager

Maintenance Supervisor

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Let's create your Critical Incident Report Form

Authors

Alex Denne

Find the exact document you need

Security Guard Report Form

Incident Notification Form

Hazard Incident Report Form

Employee Incident Report Form

Critical Incident Report Form

Security Incident Report Form

Incident Response Form

Incident Investigation Form

Download our whitepaper on the future of AI in Legal

Genie’s Security Promise

Your documents are private:

Your documents are protected:

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Innovation in privacy:

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