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Inspections
Incident Reports
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View Invoices
Current Statement
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Employee Incident/Injury Report
Incident (near miss) or Injury?
Incident (near miss)
Injury
Employee name
Employee phone
Project name
Supervisor
Witness(es)
Safety representative
Craft
Date of event
Time (include AM or PM)
Location
Field
Shop
Other
Part of body injured or exposed
Head/face
Eye
Finger/thumb
Hand (either left or right)
Wrist
Arm (either left or right)
Shoulder
Side (either left or right)
Stomach
Leg (either left or right)
Knee
Ankle
Foot (either left or right)
Back
Other (please specify)
Nature of injury/incident
Laceration
Strain/sprain
Contusion
Burn
Fracture
Foreign body
Exposure
Hernia
Other - please specify
Describe in detail how and why the incident occurred
Submit
