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Incident Notification Form

Incident Notification Form Template for Singapore

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Key Requirements PROMPT example:

Incident Notification Form

"I need an Incident Notification Form to report a chemical spill that occurred in our Singapore manufacturing facility, involving two workers who required medical attention, which needs to be submitted to MOM by January 15, 2025."

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The Incident Notification Form is a crucial document required under Singapore's workplace safety framework. It must be completed when workplace accidents, near-misses, or dangerous occurrences take place, as mandated by the Workplace Safety and Health Act. The form captures essential information including incident details, affected parties, witness accounts, and immediate actions taken. It serves multiple purposes: regulatory compliance, incident investigation, risk management, and maintaining safety records. Organizations must submit this form within specified timeframes to the Ministry of Manpower, particularly for reportable incidents.
Suggested Sections

1. Incident Details: Date, time, location, and nature of incident including sequence of events

2. Affected Parties: Information about individuals involved or affected including their role and contact details

3. Incident Description: Detailed narrative account of what occurred, including any contributing factors

4. Immediate Actions Taken: Response measures implemented and emergency actions carried out

5. Witness Information: Details of any witnesses present, including their contact information

Optional Sections

1. Medical Report Section: Details of injuries sustained, treatment provided, and medical professionals involved

2. Property Damage Assessment: Comprehensive evaluation of damage to property, equipment, or facilities

3. Environmental Impact Assessment: Analysis of any environmental consequences and containment measures

4. Root Cause Analysis: Investigation findings on the underlying causes of the incident

Suggested Schedules

1. Schedule A - Photographs: Visual documentation of incident scene, damages, and relevant evidence

2. Schedule B - Witness Statements: Detailed written accounts from all witnesses present during the incident

3. Schedule C - Medical Certificates: Copies of relevant medical documentation and certificates

4. Schedule D - Investigation Reports: Complete investigation findings, analysis, and recommendations for prevention

5. Schedule E - Regulatory Compliance Checklist: Checklist confirming compliance with relevant Singapore regulations and reporting requirements

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

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alex.den.21@genieai.co
Clauses
Incident Details
Personal Information
Injury Description
Witness Information
Location and Time
Root Cause Analysis
Immediate Actions Taken
Corrective Measures
Risk Assessment
Safety Protocols
Emergency Response
Medical Treatment
Property Damage
Environmental Impact
Confidentiality
Data Protection
Investigation Procedure
Reporting Requirements
Follow-up Actions
Documentation Requirements
Notification Timeline
Authority Notification
Insurance Claims
Worker Compensation
Training Requirements
Industries

Workplace Safety and Health Act (WSHA): Primary legislation governing workplace safety reporting in Singapore. Mandates reporting of workplace accidents, dangerous occurrences, and occupational diseases within specific timeframes (10 days for accidents). Defines reportable incidents and their classification.

Personal Data Protection Act (PDPA): Singapore's primary data protection legislation that governs the collection, use, and disclosure of personal data in incident reports. Establishes requirements for consent and data protection measures when handling personal information in incident documentation.

Work Injury Compensation Act (WICA): Legislative framework for work injury compensation in Singapore. Specifies reporting requirements for work-related injuries and establishes time limits for compensation claims and incident reporting.

MOM Regulations: Ministry of Manpower regulatory requirements including iReport system specifications, mandatory information fields for incident reporting, and official incident classification guidelines.

Industry-Specific Regulations: Sector-specific reporting requirements and protocols that vary by industry (maritime, construction, healthcare, etc.), establishing additional reporting obligations beyond general requirements.

Cybersecurity Act: Legislation governing cyber incident reporting, particularly for Critical Information Infrastructure (CII). Establishes mandatory reporting requirements for cyber breaches and security incidents.

Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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