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Employee Incident Report Form

Employee Incident Report Form Template for Netherlands

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Key Requirements PROMPT example:

Employee Incident Report Form

"I need an Employee Incident Report Form that complies with Dutch GDPR requirements and includes specific sections for chemical handling incidents, as we're a laboratory facility with strict safety protocols and regular inspections from the Labor Inspectorate."

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Document background
The Employee Incident Report Form is a crucial document required under Dutch workplace safety legislation, specifically designed to comply with the Working Conditions Act (Arbeidsomstandighedenwet) and related regulations. This form must be used whenever a workplace incident, accident, or near-miss occurs, serving as an official record for both internal documentation and potential external reporting requirements. It captures detailed information about the incident, including circumstances, involved parties, witness accounts, and immediate actions taken, while adhering to GDPR privacy requirements for handling personal data. The document plays a vital role in risk management, insurance claims, legal compliance, and the continuous improvement of workplace safety measures. It should be completed as soon as possible after an incident occurs, with copies maintained according to Dutch record-keeping requirements.
Suggested Sections

1. Incident Reporter Details: Information about the person filling out the form, including name, position, and contact details

2. Incident Basic Information: Date, time, and location of the incident

3. Affected Persons: Details of all persons involved in or affected by the incident, including employees, contractors, visitors

4. Incident Description: Detailed narrative of what happened, including the sequence of events

5. Immediate Actions Taken: Description of emergency responses and immediate actions taken following the incident

6. Injuries and Damage: Description of any injuries to persons or damage to property/equipment

7. Witness Information: Names and contact details of any witnesses to the incident

8. Report Completion: Date of report completion, signature of reporter, and immediate supervisor's acknowledgment

Optional Sections

1. Medical Treatment Details: To be included when medical attention was required, including first aid or professional medical care

2. Environmental Impact: To be included for incidents involving environmental spillage or damage

3. Equipment/Machinery Involved: To be included when the incident involved workplace equipment or machinery

4. External Authority Notification: To be included when the incident required reporting to external authorities (e.g., Labor Inspectorate)

5. Risk Assessment Review: To be included for serious incidents requiring review of existing risk assessments

6. Photos and Visual Evidence: To be included when photographic or visual evidence is available

Suggested Schedules

1. Incident Scene Diagram: Template for sketching the location and setup where the incident occurred

2. Witness Statement Form: Standard template for collecting detailed witness accounts

3. Privacy Notice: GDPR-compliant notice explaining how personal data in the report will be processed

4. Investigation Checklist: Standard checklist for ensuring all necessary information has been collected

5. Follow-up Actions Log: Template for recording subsequent actions, investigations, and preventive measures

Authors

Alex Denne

Head of Growth (Open Source Law) @ tiktok³ÉÈË°æ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co
Relevant legal definitions






























Clauses




















Relevant Industries

Manufacturing

Construction

Healthcare

Retail

Logistics and Transportation

Education

Hospitality

Information Technology

Energy and Utilities

Agriculture

Chemical Industry

Financial Services

Professional Services

Public Sector

Mining and Resources

Relevant Teams

Human Resources

Health and Safety

Operations

Facilities Management

Risk Management

Compliance

Legal

Security

Quality Assurance

Environmental Health

Production

Maintenance

Employee Relations

Works Council

Relevant Roles

Health and Safety Manager

HR Director

Facility Manager

Department Supervisor

Risk Management Officer

Compliance Officer

Operations Manager

Site Manager

Production Supervisor

Quality Control Manager

Environmental Health Officer

Security Manager

Maintenance Supervisor

Project Manager

Line Manager

Works Council Member

Chief Operating Officer

Employee Relations Manager

Industries






Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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