WORKPLACE INCIDENT FOLLOW-UP FORM
Please complete the form with accurate and detailed information to ensure a comprehensive follow-up process.
Incident Details |
Incident ID: | [IR-001-1205) |
Date and Time: | |
Location: | |
Incident Type: | |
Description: | |
Employee Information |
Employee ID: | [14-229076] |
Name: | |
Department and Job Title: | |
Contact Details: | |
Witness Information |
Name: | [Name] |
Email: | |
Phone: | |
Incident Description |
Incident Details: | The incident occurred when [Name] slipped on a wet floor in the breakroom. |
Supporting Evidence: | |
Investigation Report |
Investigator: | [Your Name] |
Contact Details: | |
Date of Investigation: | |
Findings: | |
Immediate Actions Taken |
Action Taken: | Immediate cleanup of the spill and placement of warning signs. |
Responsible Party: | |
Completion Date: | |
Preventive Measures |
Proposed Measures: | Implement regular safety training sessions. |
Responsible Party: | |
Target Completion: | |
Follow-up and Monitoring |
Follow-up Plan | Conduct quarterly safety drills. |
Responsible Party | |
Follow-up Completion | |
Additional Notes
Cameras on the incident location were not working properly. |
Thank you for your attention to detail in completing this form. Your contributions are vital in maintaining a safe and secure work environment here at [Your Company Name].
For any additional information or queries, please contact [Your Company Number] or email at [Your Company Email].
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