Skip to main contentSkip Navigation or Skip to Content

Incident Report Form

If you need assistance, contact us at

Incident Report

Personal information

Name of person reported to (fill out all that apply)

Hierarchy of control
1. Elimination
2. Substitution (use an alternative)
3. Isolate (separation from hazard)
4. Redesign (change equip/process)
5. Administration (change work practice)
6. Personal protective equipment (gloves, glasses, hearing protection)

Supervisor/instructor signature and report date

Search To Top