Lumiform / Templates / Incident report - construction site

Incident report - construction site

Use this template for the incident report for incidents involving personal injury and material damage on construction sites.

★ ★ ★ ★ ★

Rated 5/5 stars on Capterra

Say goodbye to paper checklists!

Lumiform enables you to conduct digital inspections via app easier than ever before

Cut inspection time by 50%
Uncover more issues and solve them 4x faster
Select from over 5,000 expert-proofed templates

Digitalize this paper form now

Cut inspection time by 50%
Uncover more issues and solve them 4x faster
Select from over 4000 expert-proofed templates

★ ★ ★ ★ ★

Rated 5/5 stars on Capterra

Incident report - construction site

Close Call (near miss)

Risk to personal injury only - For all asset damage, environmental or reputational events please refer to following sections.

Close Call - no person has been injured but there was a real likelihood that someone may have been injured if no action was taken.

describe event

Action and recommendations

comments

Photos

Injury

Date and Time of incident

Name of injured person

DOB of the injured person

Contact details of injured person

Address of injured person

Name and contact details of witness

Activity when injury was sustained

Where did the injury occur?

Injury Location

Type of injury

Did a first aid responder provide first aid

If no please provide reason

Name and contact details of first aid responder

Details of treatment

Did the emergency services attend?

Which emergency services attended?

please provide names and contact detail is availible

Did the injured person stop work?

State date and time

Name of treating doctor or physician

comments

Photos of incident

Asset Damage

Date and Time of incident

Type of asset that has been damaged eg: vehicle, plant, scaffold, structure etc.....

How did damage occur

Details of responsible party

Has rectification of damage been actioned

Person/organisation completing rectification work

did the incident involve any of the following

Was the emergency services regulator notified/called to the scene?

Name/s and contact details of the person attended

If any person from an emergency service or regulatory office attends the site/scene please contact your line manager and HSE immediately.

comments

Photos

Environmental Impact

Date and Time of Event

Environmental Area that has been effected

clean up requirment

Has clean up been actioned?

by who?

Did the emergency services attend the scene?

person/organisation responsible for the incident

comments

Photos

Impact to Reputation

Date and Time of Event

please provide details

Did the media attend?

what is the likelihood of media interest?

have you had any calls from the media?

comments

Photos

Previous template

Next template

Please note that this checklist template is a hypothetical appuses-hero example and provides only standard information. The template does not aim to replace, among other things, workplace, health and safety advice, medical advice, diagnosis or treatment, or any other applicable law. You should seek your professional advice to determine whether the use of such a checklist is appropriate in your workplace or jurisdiction.