Worksite Incident Report Checklist
Something happened on the construction site. Utilize this checklist to record what happened to ensure pertinent information is collected.
|1. Is this a serious emergency requiriung immediate medical attention? If yes, call 911.||Yes No N/A|
|2. What is the name(s) and title(s) of the person(s) involved?||Text Answer|
|3. Has anyone involved sustained any injuries?||Yes No N/A|
|4. If yes, please provide a description of the injury or injuries.||Text Answer|
|5. Where did this take place?||Text Answer|
|6. Provide a breif description of what happened.||Text Answer|
|7. Was any property, material or equipment damaged?||Text Answer|
|8. If yes, please provide a description of the damage.||Text Answer|
|9. What could have been done to prevent this incident?||Text Answer|
|10. Has anyone notified the general contractor of this incident?||Yes No N/A|
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