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Accident/Incident Report
Report Information
Today's Date
Job Name
Technician Name
Job Number
Incident Information
Date of Incident
Time of Incident
Location of Incident
Type of Incident
Injury
Near Miss
Property Damage
Equipment Failure
Environmental
Security
Other
People Involved
People Involved
Witnesses
Incident Details
Description of Incident
Cause of Incident
Injuries Sustained
Treatment Provided
Property/Equipment Damage
Actions Taken
Immediate Actions Taken
Future Prevention Steps
Incident Reported To
Date Reported
Any other notes or relevant information?
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