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INCIDENT REPORT 1. PERSONAL DETAILS Student number (8-digit number) Title: Dr Mr. Mrs. Ms Miss Family name: Given name: Email address (ICU email for degree students): Mobile phone: Home phone number:
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How to fill out incident report form:

01
Start by providing your personal information: Your name, job title, and contact information. This is important for identification purposes and for contacting you if further information is needed.
02
Next, provide a detailed description of the incident: Include the date, time, and location of the incident. Describe what happened, who was involved, and any relevant circumstances leading up to the incident.
03
Document any injuries or damages: Clearly state if there were any injuries or damages resulting from the incident. If there were, provide detailed information about the individuals affected and the extent of the injuries or damages.
04
Identify witnesses: If there were any witnesses to the incident, include their names, contact information, and a brief summary of what they witnessed. This can be crucial for further investigation or verification of the incident.
05
Provide any additional information: If there are any other important details or factors that should be considered, include them in the report. This could include equipment malfunctions, unsafe conditions, or any actions taken immediately after the incident to mitigate further risks.

Who needs incident report form:

01
Employers: Employers need incident report forms to keep records of any workplace incidents, in compliance with occupational health and safety regulations. these reports help employers identify potential hazards and take preventive measures to ensure employee safety.
02
Insurance companies: Incident report forms are often required by insurance companies when making claims for damages or injuries. These reports provide the necessary information to assess the validity of the claim and determine the appropriate compensation.
03
Legal authorities: In certain cases, incident report forms may be required by law enforcement agencies or other legal authorities. These reports can be used as evidence in investigations or court proceedings.
04
Employees: Employees who are involved in or witness an incident should also fill out incident report forms. This helps ensure that their account of the incident is officially documented and can be used for any further action or investigation.
Overall, filling out an incident report form accurately and comprehensively is important for capturing all relevant information about an incident and ensuring that it can be appropriately addressed and investigated.
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