Use this form to document any workplace incident on a construction site, including near misses, injuries, and property damage. Sections include title page, general incident info, date and time, location, witnesses, people involved, and detailed incident description with photo attachments. Injury reporting captures employee details, occupation, age, tenure, EMS notification, and clinic or hospital information. Property damage covers nature of damage, equipment or machinery involved, make or model, and equipment number. A lessons learned prompt supports initial investigations. After completion, export and submit to the Area Safety Supervisor for review and follow-up.
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