Incident report

What happened

Fill this in as soon as the scene is safe. Facts only. Leave the cause to the investigation.

Date of the event *

Time of the event *

Where it happened *

Type of event *

Severity *

Account of the event *

People involved

Immediate action taken *

The regulator has been notified *

Yes No Not applicable

Scene photographs

Photograph the scene before anything is moved.

Reporter signature *

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