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Employee Incident Report Form
"I need an Employee Incident Report Form for a manufacturing company with 500+ employees, compliant with RIDDOR regulations, that includes specific sections for machinery-related incidents and chemical exposure documentation."
1. Incident Details: Date, time, location, and type of incident
2. Personal Information: Details of affected employee(s) and witnesses
3. Incident Description: Detailed account of what happened
4. Immediate Actions Taken: Response measures and first aid provided
5. Reporter Information: Details of person completing the report
1. RIDDOR Reporting Section: Additional section for incidents that meet RIDDOR reporting criteria requiring HSE notification
2. Medical Assessment: Section for recording details of medical examination or treatment when medical attention was required
3. Equipment Involved: Section for documenting details of any machinery or equipment involved in the incident
1. Witness Statements: Additional detailed accounts from witnesses
2. Photographs/Evidence: Visual documentation of incident scene or injuries
3. Risk Assessment Review: Updated risk assessment following incident
Authors
Accident
Near Miss
Dangerous Occurrence
Reportable Incident
RIDDOR
First Aid Treatment
Medical Treatment
Lost Time Injury
Affected Person
Reporter
Witness
Supervisor
Work Area
Personal Protective Equipment (PPE)
Root Cause
Corrective Action
Preventive Measure
Risk Assessment
Workplace
Working Hours
Safety Representative
Competent Person
Hazard
Control Measure
Incident Details
Location and Timing
Witness Information
Injury Description
Property Damage
Environmental Impact
Immediate Response
First Aid Administered
Medical Treatment
RIDDOR Reporting
Risk Assessment
Root Cause Analysis
Corrective Actions
Prevention Measures
Equipment Involved
Environmental Conditions
Training Verification
Safety Compliance
Management Review
Follow-up Actions
Data Protection
Confidentiality
Record Keeping
Signature and Declaration
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