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Initial Incident Report
Pick a job/location
Enter Job # and location
Name of Project Superintendent/Foreman:
Name of person completing and submitting this report:
Indicate type of incident by cecking the approprite box:
Injury
Illness
First Aid
Close Call/Near Miss
Vehicle Incident
Fatality
List the employee(s) involved:
List the Vehicle ID # or Name:
Date of Incident:
Time of Incident:
12:00 AM
12:15 AM
12:30 AM
12:45 AM
01:00 AM
01:15 AM
01:30 AM
01:45 AM
02:00 AM
02:15 AM
02:30 AM
02:45 AM
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03:15 AM
03:30 AM
03:45 AM
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04:45 AM
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05:45 AM
06:00 AM
06:15 AM
06:30 AM
06:45 AM
07:00 AM
07:15 AM
07:30 AM
07:45 AM
08:00 AM
08:15 AM
08:30 AM
08:45 AM
09:00 AM
09:15 AM
09:30 AM
09:45 AM
10:00 AM
10:15 AM
10:30 AM
10:45 AM
11:00 AM
11:15 AM
11:30 AM
11:45 AM
12:00 PM
12:15 PM
12:30 PM
12:45 PM
01:00 PM
01:15 PM
01:30 PM
01:45 PM
02:00 PM
02:15 PM
02:30 PM
02:45 PM
03:00 PM
03:15 PM
03:30 PM
03:45 PM
04:00 PM
04:15 PM
04:30 PM
04:45 PM
05:00 PM
05:15 PM
05:30 PM
05:45 PM
06:00 PM
06:15 PM
06:30 PM
06:45 PM
07:00 PM
07:15 PM
07:30 PM
07:45 PM
08:00 PM
08:15 PM
08:30 PM
08:45 PM
09:00 PM
09:15 PM
09:30 PM
09:45 PM
10:00 PM
10:15 PM
10:30 PM
10:45 PM
11:00 PM
11:15 PM
11:30 PM
11:45 PM
02:30 PM
Location of Incident:
Incident Description (briefly include: sequence of events, task(s) being performed, description of injury/first aid/outcome, etc.)
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