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Incident Report
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Incident Summary
Project
Incident Location
Company
Day / Date / Time
Incident Classification
Status
Craft Name
Employee Experience – Craft
Employee Experience – Site
Immediate Actions Taken
Environmental Elements
Weather
Night Work
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Incident Description
Describe event – keep to one page
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Drawings or Pictures
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Summary
Root Cause
Corrective Action
Contributing Factor
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Swiss Cheese Model
Strategy
System
Sharp End
Accident
Triggering events
Active 6
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Post Incident Update
Incident Scene Status
Key Observations
Worker Behavior
Equipment / Tool Utilization
11/27/2018
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