Comm 1419 Incident Report Assignment – 10%

Instructions

1. Read the scenario below.

2. Following discussion and using examples discussed in class as models, create a report form that
you can use for the incident.
3. Fill in the form using the information from the scenario below.
4. Fill in any details that are not mentioned in the scenario. Use today’s date and choose a time of
the incident. Include the specific name of a hospital. Use your own name.
5. Write a few sentences to summarize the report and explain who you are and your role in the
incident (witness).
6. Submit your assignment on blackboard.

Scenario

You are an automotive technician working in a small, independent company, Sam’s Service and Repair.
Sam’s has a good client, a local fertilizer company called “Sow and Grow,” who comes to Sam’s regularly
for service and repair of their company vehicles.

One day, while one of the trucks was being serviced, a bag of chemical fertilizer which was in the truck
bed, fell over releasing a huge cloud of toxic chemicals into the air. The technician working closest to the
truck bed, Herbert, was overcome by the toxic fumes, and fell, hitting his head on the concrete floor. He
lost consciousness for a moment.

You called 911 and the paramedics came to the shop. They arrived within 10 minutes of the incident and
took Herbert to the nearest hospital for treatment. The hospital reports that Herbert has a slight
concussion and some minor upper respiratory problems, but there is no serious damage. He will make a
full recovery but will need to remain in the hospital overnight.

Because you were at the scene and saw what happened, you must write a report providing details of the
incident. This report will be sent to the boss and the insurance company.

This assignment is worth 10%. It will be completed in class in the computer lab.

Due Dates: Comm 1419-01 - Wednesday June 14 at midnight

Comm 1419-02 – Friday June 16 at midnight

Comm 1419 Incident Report Assignment – 10%

The assignment will be graded according to the rubric below.

Rubric
Form – Format & • Correct format
Organization • Adequate detail
• Headings, spacing
• Visual appeal – design
• Clear & easy to read /5
Content – • Follows 6 Cs – clear, concise, complete, correct, chronological,
Paragraph & Form courteous
• Appropriate amount of detail
• Logical explanation of information
• Direct strategy /10
Spelling & • Report has been proofread – few or no mistakes in grammar and
Grammar spelling
• Professional word choice & tone /5

Assignment will be checked for plagiarism. Plagiarized assignments will receive a grade of zero.

Mark = /20

Value = 10%