Construction Zone Collapse Incident Form

Construction Zone Collapse Incident Form
Please provide detailed information regarding the collapse incident at the construction zone.
Date of Incident
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Time of Incident
Hour Minutes
AM/PM Option
Location of Incident
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Description of Incident
Cause of Collapse (if known)
Number of Injuries
Number of Fatalities
Witnesses (Names and Contact Information)
Actions Taken Immediately After Incident
Should be Empty: