Tool 114 Incident Report


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].