Supervisor’s / Manager's Incident Investigation Report - Safety-Link Mobile App

Included Fields

Customize to add, remove, or edit any of the fields below.

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  Complete all areas of this form for each injured person.

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  Name

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  Employee

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  Visitor

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  Contractor

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  Address

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  If an Employee ID Number

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  Date of Accident

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  Time of Accident

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  Accident Area

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  Address

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  Individual’s description of the incident and/or injuries

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  Name of person incident reported to

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  Date Reported

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  Time Reported

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  Supervisor/Manager’s understanding of the incident and/or injuries

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  Witness’ Name

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  Witness’ Phone No.

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  Witness’ description of the incident and/or injuries

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  Name of healthcare provider

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  Was first aid given off-site?

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  Was employee hospitalized overnight?

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  Did death occur?

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  Hospital

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  Address

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  THIS INFORMATION IS REQUIRED BY FOR ANY INJURY REPORTS FOR EMPLOYEES

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  Date of Birth

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  Date Hired

• ...and More!