Equipment Incident Report

Please note: All incidents require a post-incident drug test on the day of the incident.

Please enable JavaScript in your browser to complete this form.

Date of Report *

Name *

First

Last

Date of Incident *

Location of Incident *

Name of Person Reporting: *

Job Title *

Supervisor's Name *

Equipment *

Was the Equipment in Use at the Time of the Incident? *

Was the Equipment Being Used Properly? *

Describe the Purpose of Equipment Use at the Time of the Incident: *

Describe What Happened: (Include specific details of the incident, actions leading up to it, and any contributing factors.) *

Was Anyone Injured? *

If yes, describe injuries and attach an injury report if applicable:

Were There Any Witnesses? *

If yes, provide names and contact information:

Was Any Property or Equipment Damaged? *

If yes, describe the damage:

Immediate Actions Taken to Address the Incident: *

Recommendations for Preventing Future Incidents: *

File Upload *

Click or drag files to this area to upload. You can upload up to 10 files.

Test

Please enable JavaScript in your browser to complete this form.

Name *

First

Last

Email *

Company *

Phone

Comment or Message *