Near miss / First-Aid / Incident / Accident

Report
Project
Location:

Name of the Project: Reporting Employee Name:

Project Location: Designation:
Clients Name: Department:
Name of the Injured Person: Contact/Mobile Number:
Incident Details:
Date of occurrence: Time of Incidence:
Incident Location:
Description of the Incident:

Corrective action initiated:

Signature of Reporting Employee:

Preventive action proposed to prevent reoccurrence:

Signature of HSE In-charge Signature of Site-in-Charge

Document Name: HSE/CHLST/INCIDENT REPORT. Rev/R1