Incident Report Form: Employee Involved (Complete Both Boxes) Customer/Visitor/Employee Involved
Incident Report Form: Employee Involved (Complete Both Boxes) Customer/Visitor/Employee Involved
Incident Report Form: Employee Involved (Complete Both Boxes) Customer/Visitor/Employee Involved
To be completed by the employee or customer/visitor immediately following any incident that resulted in
injury or property damage, and turned into the supervisor. The supervisor should conduct their own
investigation and turn in all necessary reporting forms to the insurance agent or carrier.
Note: This form is a supplement to, not a substitute for, the First Report of Injury on worker injuries.