Tool 114 Incident Report

RAINBOW CLUB AUSTRALIA

Incident Report
Name of person making the incident report:
Date incident occurred: Date report made:
Time of incident:
Location of incident:
Did the incident cause harm to: [please tick the relevant item/s]
□ Person/s □ Assets □ Environment □ Organisation’s reputation
Describe what occurred: 

 

Name/s of person/s involved in the incident and how they were involved and the nature of any injuries: 

 

Describe the nature, date and time of any first aid treatment, if applied: 

 

Witnesses:Name:Contact details: 
Immediate action taken: 

 

 Incident reported to: 

 

Incident report entered in Incident Management Register by General Manager on ________________[date].