Incident Report Form
Incident Report Form
Employee Name: ___________________________________
Employee ID: ______________________________________
Position: ___________________________________________
Date & Time of Incident: ______________________________
Location of Incident: _________________________________
Description of Incident: _______________________________
Injuries or Damage: __________________________________
Witness(es): _________________________________________
Employee Signature: __________________________________
Date: ________________________________________________
Manager Signature: ___________________________________
Date: ________________________________________________