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Safety
Safety
Incident Report
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Contact Us
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912.367.5707
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912.367.5707
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Incident Report
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Date / Time of Incident
*
Date
Time
Check All That Apply:
*
Near Miss
Unsafe Act
Unsafe Condition of Area
Unsafe Condition of Equipment
Unsafe Use of Equipment
Failure to follow Procedure/Policy
Safety Concern
Safety Suggestion
Describe the incident/potential incident/hazard/safety concern in as much detail as possible: (Please do not include employee names in the description.)
*
Corrective Action/Safety Recommendation: (Optional)
Safety Concern: (Details)
Safety Suggestion: (Details)
Include pictures when possible. (Please do not include employees in the pictures.)
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