Incident and Near Miss Reporting

Date and time of incident

दिन

माह

वर्ष

समय

घंटेमिनट

Location (site/room/online setting)

Name(s) of people involved

Email

Provide a clear, factual description of the incident or near miss

Details of actions taken (e.g. who provided first aid or time emergency services were called)

Approximate number of individuals affected

What do you think caused the incident or near miss?

What steps have been or will be taken to prevent recurrence?

If witnesses, please enter contact details

Witness statement taken?

Signature

ड्राइंग मोड चयनित। चित्र बनाने के लिए माउस या टचपैड की आवश्यकता होती है। कीबोर्ड पहुंच के लिए, टाइप या अपलोड का चयन करें.