Incident report forms

This section identifies the accountabilities, responsibilities, information flow, and specific tasks to complete as soon as any incident is identified. It describes the initial incident report form and minimum requirements for satisfactory completion. 

The kit contains a detailed incident report form. The kit instructions are signed and dated by the sampler as a true and accurate record of the process, and are designed to be retained by the sampler as contemporaneous notes for use in court. The kit is suitable for both destructive and nondestructive testing, and can also be used for sampling suspects in cases involving the theft of metals. 

The incident will have to be reported using the facility s incident report form such as that shown in Table 11.1. (The space for written information provided in Table 12.1 has been compressed here in order to fit into a book format.) Generally, the information on this form will go directly into an incident tracking database or incident register. 

Some of the incident report forms collected direct the person completing the form to select the worker s unsafe act or an unsafe condition as the causal factor, in that order. Having selected an unsafe act as the causal factor, the person completing the report often stops there. 

Hazardous Materials Incident Report (Form DOT F 5800.1) and Instructions... 

A process for incident reporting and investigation should be estabfished, with an emphasis on free exchange of information without penalty to the persons who report an incident (see Appendix G for a sample incident report form). The objectives are to maintain a culture in which people feel comfortable in sharing information about problems they have encountered and promote an understanding that laboratory workers personal safety is paramount. 

What do I need to do to complete the OSHA 301 Incident Report You must complete an OSHA 301 Incident Report form, or an equivalent form, for each recordable injury or illness entered on the OSHA 300 Log. 

I (a) Basic requirement. You must save the OSHA 300 Log, the privacy case list (if one exists), the annual summary, and the OSHA 301 Incident Report forms for five (5) years following the end of the calendar year that these records cover. 

The incident report form (discussed earlier) is the basic starting point for any internal system. Each organization needs to iay down what the system involves and who is responsibie to do each part of the procedure. This wiii invoive ... 

The OSHA 301 Injury and Illness Incident Report replaces the OSHA Form 101. For each recordable injury or illness on the 300 Log, complete an OSHA 301 Incident Report form, or an equivalent. The 301 is designed to accommodate lengthier, detailed information about the incident. Many employers use a workers compensation or an insurance form instead of the 301 Incident Report, or supplement a workers comp/insurance form by adding any additional information required by OSHA. Record the injury or dlness within seven calendar days of receiving information that it occrured. 

A question often asked is whether or not the reporter s name should be required on the near miss incident report forms and appear on the subsequent weekly or monthly summary. It may be that general publication of near miss incident reports could create peer pressure if employees realize the near miss incident information was to be widely publicized within the organization. If near miss incidents are widely reported, employees will be exposed to many reports and an additional report should not draw attention to the reporter, thereby minimizing peer pressure. 

MODEL 9.1 Example of a near miss incident reporting form. 

What is important is the feedback and action instigated by management to rectify the hazard if the event reported wasn t already closed out at the time of the report. For example, an employee notices some 2 x 4s with protruding nails laying in the walkway. He removes the nails and places the wood in a proper storage area. He then fills in the near miss incident report form as follows ... 

Write a conprehensive account of the hanging and your management expect a Serious Incident (SI) investigation, and scrutiny of your notes. Update John s risk assessment and help nursing staff corrplete incident report forms. 

Figure 12.13 From FDR1 (94) Fire incident reporting form. Crown Copyright materiai is reproduced with the permission of the Controller of HMSO and Queen s Printer for Scotiand.

Is there an in-house posting of where to report incidents and obtain incident report forms ... 

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