The Incident Report Form
Section I. Background
This section records basic background information about the incident, including who was involved, witnesses, the date and time, work shift, location, department, equipment involved, and other relevant details. Record this information accurately because it may be needed later to support the investigation findings, corrective actions, or follow-up.
Section II. Description of the Incident
This section describes the sequence of relevant events before, during, and immediately after the incident. Arrange the events in chronological order so that someone unfamiliar with the incident can clearly understand what happened.
Keep the description factual and objective. Describe what the evidence establishes without adding assumptions about why an event occurred or who was at fault. Causal findings and supporting evidence are documented in the sections that follow.
Below is a sample Section II Description of the incident.
Section II: Description of the Incident
- Employee #1 and Employee #2 began laying irrigation pipes in a 3 ft ditch.
- Employee #1 oriented an irrigation pipe vertically.
- The pipe contacted a high-voltage power line directly over the work area.
- Employee #2 saw Employee #1 falling into an irrigation ditch.
- Employee #2 pulled Employee #1 from the irrigation ditch.
- Employee #2 ran about 600 ft to his truck.
- Employee #2 placed a 911 call for help on his mobile phone.
- Employee #2 ran back to Employee #1.
- Approximately five minutes later, paramedics arrived.
- Paramedics began resuscitation efforts.
- Paramedics transported Employee #1 to the hospital for treatment.
Knowledge Check Choose the best answer for the question.
8-3. What is most important when writing the description of an incident?
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