Safety Incident Report

Safety Incident Report

Injury, Equipment Damage, Utility Strike, or Property Damage
Following an incident involving an injury, equipment damage, utility strike, or property damage, fill out this form to give as much information as possible to the Safety Department.

If you are able to, please submit a couple photos of the injury, equipment, or scene.

Once you submit this form, please contact Ben immediately.

In the event of an emergency, dial 911 first.

Phone: (515) 497-6124
What type of incident are you reporting?*
Type of Utility Strike*
Other Utility*
Your Name*

First NameLast Name
Division Involved*
Person(s) Involved

Description of Equipment Damage Report
** If auto collision, notify law enforcement and take photos. **
Unit # of equipment involved in incident.*
Use a comma (,) to separate if multiple.
Was someone other than Absolute Group involved in the incident?*

YesNo
Was law enforcement contacted?*

YesNo
List vehicles other than Absolute Group's that were involved.*
Describe the cause and extent of the damage IN DETAIL.*
ALWAYS take photos of our equipment/vehicles.

ALWAYS take photos of the non-Absolute Group equipment/vehicles involved.

ALWAYS take photos of the scene for reference.

Date, Time, and Location of Incident