Employee Incident Report Form (Part 1) Logo

  • Employee Incident Report Form

    Please use this form to submit an incident report for a Corporate Employee or visitor at the North Quay office. Incidents involving Employee Helpers will be submitted via the Member & Helper Incident Report Form. An incident is an event or set of circumstances which could have resulted or did result in harm, illness, loss, property damage, or disruption to normal services.
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  • Describe the incident - using the ISBAR framework, describe what happened and what immediate actions you took.

    ISBAR

    • Introduction - who are you, your role, and the type of incident
    • Situation - describe what happened
    • Background - describe what happened leading up to the incident
    • Assessment - state what you saw, heard, said and did
    • Recommendation - ask any questions you may have or follow up you recommend

    Example:

    I am the employee involved in the incident.  While working in the North Quay office, I caught my fingers between their chair and desk which caused me immediate pain.  I had sat down in the chair, swung around, and my hand was on the edge of the desk.  I went to the Site Administrator and first aid was applied through an ice pack.  I reported the incident to my line manager who suggested I see my GP to have my hand reviewed as it had started to swell.

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