wikiHow
Incident Report Example
1. Incident Details:
Date and time of the incident: January 15, 2023, 2:30 PM
Location of the incident: Main Warehouse, Building A
Incident ID/Reference number: IR2023-001
Description of the incident: Slip and fall accident in the warehouse aisle
2. Incident Category:
Safety
3. Reported By:
Name of the person reporting the incident: John Smith
Contact information: john.smith@example.com, (555) 123-4567
4. Involved Parties:
Names and roles of individuals involved in the incident:
Employee: Sarah Johnson (Warehouse Staff)
Supervisor: Mark Davis
Contact information of involved parties: Sarah Johnson - sarah.johnson@example.com, (555) 987-6543
5. Witness Information:
Names and contact information of witnesses, if applicable:
Witness: Emily Brown - emily.brown@example.com, (555) 789-0123
6. Incident Description:
While performing her regular duties, Sarah Johnson slipped on a wet surface in aisle 5 of the warehouse. She fell and sustained minor injuries, including a sprained wrist. The incident occurred due to a leaking pipe above the aisle, causing water to accumulate on the floor.
7. Impact Assessment:
Sarah Johnson sustained a sprained wrist and received immediate medical attention from the onsite first-aid team.
No significant damage to products or equipment was reported.
Temporary closure of aisle 5 for cleanup and investigation.
8. Immediate Actions Taken:
Mark Davis, the supervisor, immediately called the first-aid team and ensured Sarah received medical attention.
The maintenance team was notified and dispatched to address the leaking pipe and clean up the area.
A caution sign was placed to warn employees about the wet floor.
9. Investigation and Analysis:
The maintenance team inspected the leaking pipe and determined it was a result of a loose connection.
The accumulation of water on the floor was found to be a result of inadequate drainage in the area.
Interviews were conducted with Sarah Johnson and the witness, Emily Brown, to gather additional information about the incident.
10. Corrective Actions:
The maintenance team immediately repaired the leaking pipe and ensured all connections were secure.
A review of the drainage system in the warehouse is scheduled to prevent future water accumulation incidents.
Enhanced safety protocols will be implemented, including regular inspections of high-risk areas and prompt response to any identified hazards.
11. Follow-up and Communication:
The incident was reported to the safety manager, who will review the incident report and determine if further actions or investigations are necessary.
The incident was communicated to all warehouse staff through a safety bulletin, emphasizing the importance of promptly reporting any safety hazards.
Sarah Johnson's supervisor, Mark Davis, will follow up with her regarding her recovery and any necessary work adjustments.
12. Additional Documentation:
Attached photographs of the wet floor, leaking pipe, and caution sign.
This example provides a structure for an incident report, but it's important to tailor it to the specific incident and organizational requirements. The report should be objective, factual, and include all relevant details to facilitate a comprehensive understanding of the incident and support decision-making for preventive measures.
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