Workplace Incident Report

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Document workplace incident by submitting this report.

An incident report is a formal recording of the facts related to a workplace accident, injury, or near miss. Its primary purpose is to uncover the circumstances and conditions that led to the event in order to prevent future incidents.

Branch Name (e.g. Jmall, AyalaCB) *

Team Lead Name *

Incident Date *

YYYY

Name of the employee(s) involved *

Incident Type *

Injury - First Aid

Property Damage

Property Loss

Equipment Failure

Theft

Specific Location of the Event *

For example: Inside the store

Incident Description (Include all events that led up to the incident) *

Submit

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