Incident Report Slip

Incident Report Slip

Incident Details

Date of Incident:

[December 10, 2050]

Time of Incident:

[2:15 PM]

Location of Incident:

Main Office Building, Conference Room 3

Type of Incident:

Fire Emergency

Description of Incident: 

A small fire erupted due to an electrical short circuit in the projector. The fire was contained within 10 minutes with minimal damage.

Affected Parties

Number of Injured Persons:

0

Number of Affected Employees:

5

Names of Affected Employees:

  • John Doe

  • Jane Smith

  • Michael Johnson

  • Emily Davis

  • Richard Brown

Response and Actions Taken

Immediate Actions Taken:

  • Activation of fire alarm

  • Evacuation of personnel from the room

  • Use of fire extinguisher to contain the fire

Emergency Services Contacted:

Local Fire Department

Time of Response by Emergency Services:

[2:25 PM]

Further Actions Taken:

  • Electrical system inspection

  • Repair and replacement of damaged equipment

  • Debriefing and counseling session for affected employees

Approval and Sign-Off

Prepared By: [Your Name]

Reviewed By: [Your Supervisor Name]

Date: December 11, 2050

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