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ACCIDENT & NEAR-MISS REPORT

Internal incident documentation form for event hire businesses

Add Your Company Name
Add Your Email Address
Add Your Phone Number
Add Your Address
Incident Classification
Incident Details
Select date and time...
Enter specific location or address
Event Information
Enter name of event if applicable
Reporter Information
Enter client or organization name
Injured Party Details
First name input
Injury Assessment
Surname input
Medical Response
Enter email...
Equipment and Environment
Enter phone...
Incident Description
e.g. Event Manager Technician Setup Crew
Cause Analysis
Leave blank if no person was injured
Witnesses and Evidence
e.g. Staff Client Guest Vendor
Response Actions
Select option --
Options: None, Minor Cut/Scrape, Bruise, Sprain/Strain, Laceration, Burn, Electric Shock, Fall Injury, Back Injury, Other
Prevention Recommendations
Follow-up
Describe first aid given ambulance called hospital visit etc
Assessment
List any equipment or machinery involved
Reporting
... and 4 more options
Authorization
Provide a comprehensive account of what happened
What directly caused the incident?
What conditions or actions contributed to the incident?
List names and contact details of witnesses
Upload file...
Upload any photos of the incident scene or damage
Describe actions taken immediately after the incident
What could be done to prevent similar incidents?
Describe required follow-up actions and timeline
(1 = Poor, 5 = Excellent)
Digital signature field
How to Use This Template

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  1. Click "Clone Template" to copy it to your private template library
  2. Customize the fields as needed for your specific use case
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