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Free Workplace Incident Feedback Questionnaire Template

Free Workplace Incident Feedback Questionnaire

Name: Free Workplace Incident Feedback Questionnaire Template
Brand: Template.net
Availability: InStock

Workplace Incident Feedback Questionnaire

Please fill out the following information for our records. Your input is valuable to us.

Date of Incident

Please enter the date the incident occurred.

Your Full Name

Please enter your full name, including your middle name if applicable.

Contact Email

Please provide your email address for us to contact you.

Incident Description

Please describe the incident in detail.

Incident Location

Where did the incident take place?

Office

Warehouse

Factory Floor

Parking Lot

Other

Identified Cause

What was the primary cause of the incident?

Human Error

Equipment Failure

Environmental Factor

Procedure Breach

Other

Were there any witnesses?

Please specify if there were any witnesses present during the incident.

Yes

Was there any injury?

Indicate whether any individual was injured as a result of the incident.

Yes

Preventive Measures

What measures do you suggest to prevent this incident from happening again?

Thank You for Your Feedback!

Your responses help us ensure a safer workplace.

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Introducing the Workplace Incident Feedback Questionnaire Template from Template.net. Crafted for efficiency, this editable and customizable template streamlines incident feedback collection effortlessly. Tailor questions to your specific needs with ease using our Ai Editor Tool. Simplify incident reporting and analysis seamlessly with this indispensable tool.