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Explanation and Guide

Form:

Employees Incident Report

Purpose:

This is used to document the incident that occurred


during the operation of the business. It contains the
reasons why the incident happened and the
recommendation of the immediate supervisor. The
text in red and sections underlined in red indicate
terms that will be unique to the particular
circumstance (e.g. names of companies).

Name of Company

Incident Report Form


Date: ______________
INCIDENT:

Breakage
Losses

CRR Violation

Others ________

Shortage

SUMMARY:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________
PERSONNEL INVOLVED:
1. _________________________ 2. _________________________
3. _________________________ 4. _________________________
5. __________________________ 6. _________________________
ANALYSIS:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________
RECOMMENDATION:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________
ACTION TAKEN:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________
Noted by:

Submitted by:

__________________

______________________

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