Incident Reporting Training Certification Form
Certify your completion and understanding of incident reporting training. Please fill out all required fields to receive your certification.
Participant Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Department or Unit
*
Date of Training Completion
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Trainer/Instructor Name
*
Training Module or Course Title
*
Please rate your understanding of the incident reporting process:
*
1
2
3
4
5
Select the correct steps in incident reporting (choose all that apply):
*
Identify and document the incident
Notify the relevant supervisor or manager
Submit the report to the appropriate department
Wait for someone else to report it
Other
What is the primary purpose of incident reporting?
*
To assign blame for incidents
To improve safety and prevent future incidents
To comply with regulations only
Other
Briefly describe the most important thing you learned from this training.
*
Participant Signature
*
Submit Certification
Submit Certification
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