EHS Incident Report Form: Workplace Accident
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Incident Details
Injury Assessment
Root Cause Analysis
Corrective Actions
Location
Date & Time of Incident
Reported By (Name & Position)
Date of Accident
Time of Accident
Location of Accident
Accident Description
Persons Involved
Witnesses
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Workplace Accident
Environmental Spill
Near Miss
Hazardous Exposure
Fire Incident
Equipment Failure
Ergonomic Assessment
Compliance Violation