Employee Incident Report Form Template for Indonesia

1. Environmental Impact: Assessment of any environmental effects - required for incidents involving chemical spills or environmental hazards

2. Equipment/Machinery Involved: Detailed information about any equipment or machinery involved in the incident - required for equipment-related incidents

3. Third Party Involvement: Information about any contractors, visitors, or external parties involved - required when non-employees are affected

4. Medical Report Section: Detailed medical assessment and treatment information - required for incidents resulting in significant injury

5. Cost Impact Assessment: Evaluation of financial impact including property damage, lost time, and other costs - required for major incidents

6. BPJS Notification Details: Specific information required for social security reporting - required for incidents requiring BPJS notification

1. Incident Scene Photographs: Labeled photographs documenting the incident scene and any visible damage or hazards

2. Witness Statements: Detailed written accounts from witnesses, signed and dated

3. Medical Documentation: Copies of relevant medical reports or first aid records

4. Risk Assessment Form: Updated risk assessment for the activity/area involved in the incident

5. Equipment Inspection Records: Relevant maintenance or inspection records for any equipment involved

6. Investigation Checklist: Standard checklist to ensure all necessary investigation steps are completed