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INCIDENT REVIEW FORM This form is used by the Health & Safety Committee to document the review of workplace incidents. Please attach a separate sheet if necessary. Incident Occurred: LOCATION: DATE:

How to fill out incident review form

How to Fill Out an Incident Review Form:

1. Start by obtaining a copy of the incident review form. This may be provided by your employer or organization, or it could be available online.
2. Begin by filling out the basic information section of the form. This typically includes details such as the date and time of the incident, the location, and any individuals involved.
3. Provide a detailed description of the incident. Be as specific as possible, including any relevant facts, observations, or statements from witnesses. Use objective language and avoid speculation or assumptions.
4. If there were any contributing factors or root causes that led to the incident, list them in a separate section. This could include equipment malfunctions, communication issues, or human error.
5. Indicate the severity of the incident using a scale or rating system provided on the form. This can help prioritize actions for prevention and corrective measures.
6. If there were any injuries or damages resulting from the incident, document them clearly. Include any medical treatment administered, property damage, or other consequences.
7. Consider including information on any immediate actions taken to address the incident. This may involve contacting emergency services, implementing temporary fixes, or notifying supervisors.
8. Finally, sign and date the incident review form. This signifies that the information provided is accurate and complete to the best of your knowledge.

Who Needs an Incident Review Form:

1. Employers or organizations that prioritize safety and risk management typically require incident review forms. This helps them gather accurate information about incidents in the workplace and take appropriate actions to prevent future occurrences.
2. Incident review forms are essential for employees working in high-risk industries such as construction, manufacturing, healthcare, or transportation. These individuals need to report incidents to ensure a comprehensive review of potential hazards and improve safety protocols.
3. Incident review forms are beneficial for regulatory compliance. Certain industries have strict reporting requirements for incidents, and these forms help companies meet legal obligations.

In summary, filling out an incident review form involves providing detailed information about the incident, identifying contributing factors, documenting any injuries or damages, and indicating immediate actions taken. Employers and individuals in high-risk industries typically require incident review forms for safety and regulatory purposes.

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What is incident review form?

The incident review form is a document used to report and analyze incidents that occur within an organization.

Who is required to file incident review form?

Any individual who witnesses or is involved in an incident is required to file an incident review form.

How to fill out incident review form?

The incident review form can be filled out by providing detailed information about the incident, including date, time, location, individuals involved, and a description of what happened.

What is the purpose of incident review form?

The purpose of the incident review form is to document and investigate incidents in order to prevent them from occurring in the future.

What information must be reported on incident review form?

Information such as date, time, location, individuals involved, description of the incident, and any actions taken in response to the incident must be reported on the incident review form.