The Health And Safety Incident Report Form is a crucial document required under Indian workplace safety legislation, particularly the Occupational Safety, Health and Working Conditions Code, 2020, and associated regulations. This form must be completed whenever a workplace incident occurs, including accidents, injuries, near-misses, dangerous occurrences, or occupational illnesses. It serves multiple purposes: ensuring legal compliance with reporting requirements, documenting incidents for insurance and compensation purposes, facilitating incident investigation and prevention, and maintaining organizational safety records. The form should be readily available to all employees and must be completed as soon as possible after an incident occurs, typically within 24 hours. It forms part of an organization's broader health and safety management system and may be required by authorities, insurance providers, or during safety audits.
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.
Your data doesn't train Genie's AI
You keep IP ownership聽of your docs
1. Incident Identification: Unique reference number, date and time of report, date and time of incident
2. Reporter Details: Name, position, and contact information of the person completing the report
3. Incident Location: Specific location details including department, area, or exact spot where incident occurred
4. Incident Type Classification: Category of incident (injury, near-miss, property damage, environmental, etc.)
5. Affected Person(s) Details: Information about injured/affected persons including name, employee ID, job title, department
6. Incident Description: Detailed account of what happened, including sequence of events and immediate actions taken
7. Injury/Damage Details: Nature and extent of any injuries or damage caused
8. Immediate Response Actions: First aid administered, emergency services called, area secured, etc.
9. Witness Information: Names and contact details of any witnesses to the incident
10. Initial Risk Assessment: Immediate evaluation of hazards and risks related to the incident
1. Environmental Impact: Details of any environmental effects - required if incident involved spills, emissions, or environmental damage
2. Equipment/Machinery Involved: Details of any equipment or machinery involved - required for incidents involving mechanical failures or equipment-related injuries
3. Third Party Involvement: Information about any contractors, visitors, or members of public involved - required if non-employees are affected
4. Medical Treatment Details: Specific information about medical treatment provided - required for incidents involving injuries requiring medical attention
5. Property Damage Assessment: Detailed assessment of damage to property - required for incidents involving property damage
6. Production Impact: Details of any impact on production or operations - required for incidents affecting business operations
7. Chemical Exposure: Details of chemical exposure including substance name, quantity, exposure duration - required for chemical-related incidents
1. Incident Scene Photographs: Photographs documenting the incident scene, damage, or hazardous conditions
2. Witness Statements: Written statements from witnesses collected immediately after the incident
3. Medical Reports: Copies of any medical reports or certificates related to the incident
4. Risk Assessment Forms: Completed risk assessment forms relevant to the activity being performed
5. Equipment Inspection Records: Recent inspection records of any equipment involved in the incident
6. Training Records: Relevant training records of affected persons
7. Site Plan/Layout: Marked-up site plan showing incident location and relevant details
Find the exact document you need
Patient Safety Incident Reporting Form
A standardized form for reporting patient safety incidents in Indian healthcare facilities, compliant with national healthcare regulations and safety standards.
Download
Health And Safety Incident Report Form
A standardized form for recording workplace health and safety incidents in compliance with Indian safety regulations, facilitating incident documentation and investigation.
Download
Hazard Report Form
A standardized hazard reporting document compliant with Indian workplace safety regulations for systematic identification and reporting of workplace safety concerns.
Download
Hazard Incident Report Form
A comprehensive incident reporting form for documenting workplace hazards and accidents in India, ensuring compliance with national safety regulations and documentation requirements.
Download
Work Place Injury Report Form
A standardized form for documenting workplace injuries in accordance with Indian labor laws, ensuring proper recording and reporting of occupational accidents and incidents.
Download
Employee Incident Report Form
A standardized Indian workplace incident reporting form for documenting accidents, injuries, and near-misses in compliance with Indian labor laws and safety regulations.
Download
Critical Incident Report Form
A standardized form for documenting critical incidents in Indian workplaces, ensuring compliance with national safety regulations and reporting requirements.
Download
Security Incident Report Form
An Indian-compliant Security Incident Report Form for documenting and reporting cybersecurity incidents under CERT-In guidelines and IT Act requirements.
Download
Incident Response Form
A standardized Indian incident response documentation form for reporting security incidents in compliance with CERT-In guidelines and IT Act requirements.
Download
Incident Investigation Form
A standardized form for documenting and investigating workplace incidents in compliance with Indian safety regulations and the Factories Act 1948.
Download
骋别苍颈别鈥檚 Security Promise
Genie is the safest place to draft. Here鈥檚 how we prioritise your privacy and security.
Your documents are private:
We do not train on your data; 骋别苍颈别鈥檚 AI improves independently
All data stored on Genie is private to your organisation
Your documents are protected:
Your documents are protected by ultra-secure 256-bit encryption
We are ISO27001 certified, so your data is secure
Organizational security:
You retain IP ownership of your documents and their information
You have full control over your data and who gets to see it
.png)