Scrap Baler Incident Report Form
Please complete this form to report a scrap baler incident. Provide as much detail as possible to help us understand and address the incident.
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
*
Describe what happened
*
Names of personnel involved
*
Equipment involved (include make/model if known)
*
Type of incident
*
Please Select
Near miss
Injury
Property damage
Equipment malfunction
Other
Severity of incident
*
Please Select
Minor
Moderate
Severe
Did injury or property damage occur?
*
Injury
Property damage
Both
Neither
Immediate action taken
*
Possible cause(s) of the incident
*
Submit Incident Report
Should be Empty: