Incident Report

  1. Incident Type
  2. Outcome/Result
  3. Body Part(s) Affected
  4. Equipment/Tools Involved
  5. People Involved
  6. Contributing Factors (Behaviors)
  7. Contributing Factors (Conditions)

This checklist can be used to document most incidents (Medical/First Aid Injuries, Property Damage, Vehicular, Near-Misses, etc.)