Initial Incident Notification
TYPE - DATE
Date of Incident
Month Day Year
Date
Time of Incident
Hour Minutes
AM/PM Option
Date of Notification to Safety Department
Month Day Year
Date
Time of Notification to Safety Department
Hour Minutes
AM/PM Option
Department
Project Name / Location
Job Number
Weather
Temperature
Type of Incident
Reportable to.....?
Form Completion by
Person who notified Safety Department
Subcontractor/Vendor Involved (If applicable)
Name of Subcontractor/Vendor worker involved (if applicable)
Description of injury/damage or loss (specific details)
Immediate Action(s) Taken
Attach an image(s)
Cancelof
Superintendent email
example@example.com
Other email
example@example.com
Should be Empty:

Initial Incident Notification