Trench Collapse Incident Report
Please provide detailed information about the trench collapse incident to ensure proper investigation and corrective actions.
Date and Time of Incident
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Location of Incident
*
Name of Person Reporting
*
First Name
Last Name
Contact Information of Reporter (Phone or Email)
*
Describe What Happened
*
Were there any injuries or fatalities?
*
No injuries or fatalities
Injuries
Fatalities
Names of Injured or Deceased (if applicable)
Contributing Factors (select all that apply)
*
Improper shoring or shielding
Soil conditions
Weather conditions
Heavy equipment nearby
Lack of inspections
Other
Corrective Actions Taken
*
Names of Witnesses (if any)
Upload Photos or Documentation (if available)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Signature of Reporter
*
Submit Report
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