Instructions: Supervisors shall use this form to all work-related incidents, injuries or an “near miss” events ( which could have caused an injury/incidents). This will help us to identify and correct hazards before they happen. This form shall be completed by a supervisor and submitted as soon as possible to management for review and determination of action.
Instructions: Employees shall use this form to all work-related incidents, injuries or an “near-miss” events ( which could have caused an injury/incidents). This will help us to identify and correct hazards before they happen. This form shall be completed by the employee and submitted as soon as possible to supervisor from the department in which the incident occurred in for review and determination of action.