Incident Report - First Response Checklist for Construction
Construction
Quickly gather the facts. Collect evidence about an incident, accident or injury. Conduct full investigations quickly with this incident report template.
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Audit

First Incident Details

Date & Time of Incident
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Address

Location of Incident
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Incident Priority?
Urgent
High
Medium
Low
Trivial
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Site / Project Name
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Incident Type?
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Please describe type of incident
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Name of on-duty supervisor at time of incident?
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Is immediate medical attention required?
Yes
No
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What kind of medical attention was administered?
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Describe What Happened

Describe what happened. Please be detailed but state only facts.
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What were the weather / environmental conditions at the time of the incident?
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Describe the weather / environmental conditions at the time of the incident
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Record Evidence and Information

Which of the following do you need to attach to this report to accuractly document this incident?
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Evidence Log

Evidence Description
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Evidence ID number (if applicable)
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Type of evidence
Document
Photos
Other
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Photos of evidence (if applicable)
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Please detail any further information regarding this evidence (if applicable)
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Vehicle Log

Vehicle Make
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Vehicle Model
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Vehicle Registration
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Driver (if applicable)
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Photos of equipment (if applicable)
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Please detail any further information regarding this vehicle (if applicable)
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Damage Log

Damage description
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ID number (if applicable)
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Photos of damage (if applicable)
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Please detail any further information regarding this damage (if applicable)
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Other Items Log

Item description
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ID number (if applicable)
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Photos of item (if applicable)
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Please detail any further information regarding this item (if applicable)
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Equipment Log

Equipment Make
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Equipment Model
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Equipment ID number (if applicable)
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Photos of equipment (if applicable)
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Please detail any further information regarding this equipment (if applicable)
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People involved

Person

Full Name
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ID number
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Contact phone number
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What is this person's relation to the incident? (select all that apply)
Search and select all that apply
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Describe this person's relation to the incident
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Please describe this person's involvement with the incident, including all relevant information
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Does this person wish to make a preliminary statement?
Yes
No
N/A
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Preliminary Statement

Statement regarding incident
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Signature

Person Signature
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Has this person sustained an injury?
Yes
No
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Injury Details

Type of injury or illness? (select all that apply)
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Describe type of injury or illness
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Parts of body affected? (select all that apply)
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Please describe injury location
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Describe this injury or illness
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What was the cause of this injury or illness?
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Corrective Actions

Are corrective/further actions required with regard to this incident?
Yes
No
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Have all required corrective actions been added as Actions to this inspection?
Yes
No
N/A
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Sign Off

Further action/follow-up/investigation required?
Yes
No
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Name of person/people to follow up
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Signature

Name & Signature of Reporter
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