The Critical Incident Report Form is a fundamental document required by Canadian workplace safety legislation and regulatory frameworks. It serves as an official record of significant workplace incidents, accidents, injuries, or near-misses that require formal documentation and potential regulatory reporting. The form is designed to capture comprehensive information about the incident, including circumstances, involved parties, immediate actions taken, and follow-up measures required. This document is essential for compliance with various Canadian federal and provincial regulations, including the Canada Labour Code, provincial Occupational Health and Safety Acts, and industry-specific safety requirements. It also supports internal risk management, insurance claims, workers' compensation processes, and continuous improvement of safety protocols. The Critical Incident Report Form must be completed promptly following any significant incident and maintained as part of the organization's safety records.
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1. Incident Identification: Basic details including date, time, location, and incident reference number
2. Reporter Information: Details of the person completing the report, including name, position, contact information, and relationship to the incident
3. Incident Classification: Category and severity level of the incident based on standardized classification criteria
4. Incident Details: Comprehensive description of what occurred, including sequence of events and immediate actions taken
5. Persons Involved: Information about all individuals involved, including victims, witnesses, and responders
6. Immediate Response Actions: Details of emergency response procedures implemented and immediate steps taken to control the situation
7. Impact Assessment: Evaluation of the incident's impact on people, property, operations, and environment
8. Root Cause Analysis: Initial assessment of factors contributing to the incident
9. Corrective Actions: Immediate and planned actions to prevent recurrence
10. Notifications Made: List of all parties notified of the incident, including timestamps and methods of communication
1. Environmental Impact: Detailed assessment of environmental effects and compliance with environmental regulations, required for incidents involving environmental hazards
2. Equipment/Property Damage: Detailed description of damage to equipment or property, including cost estimates, required when physical assets are affected
3. Medical Response Details: Specific information about medical treatment provided, required for incidents involving injuries or health issues
4. Security Breach Details: Information about security-related aspects, required for incidents involving security breaches or unauthorized access
5. Media/Public Relations: Documentation of media involvement and public communications, required for high-profile incidents
6. Regulatory Compliance: Specific details required for regulatory reporting, included when incident falls under specific regulatory requirements
7. Business Continuity Impact: Assessment of impact on business operations and continuity plans, required for incidents affecting operational capability
1. Appendix A - Incident Scene Documentation: Photos, diagrams, or sketches of the incident scene
2. Appendix B - Witness Statements: Standardized forms containing detailed witness accounts
3. Appendix C - Evidence Log: Detailed log of all evidence collected related to the incident
4. Appendix D - Medical Reports: Copies of relevant medical documentation and first aid reports
5. Appendix E - Risk Assessment Matrix: Standard risk assessment tool for incident classification
6. Appendix F - Notification Checklist: Standard checklist for required internal and external notifications
7. Appendix G - Investigation Follow-up Form: Template for documenting subsequent investigation findings and actions
8. Appendix H - Relevant Procedures: Copies of relevant standard operating procedures or emergency response protocols that were activated
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