The Hazard Incident Report Form is a crucial documentation tool required by Canadian occupational health and safety legislation for recording workplace incidents, accidents, and potentially dangerous situations. This document must be completed whenever a workplace hazard is identified, an incident occurs, or a near-miss situation is observed. It serves multiple purposes: ensuring regulatory compliance, documenting incident details for investigation and insurance purposes, tracking safety metrics, and supporting continuous improvement in workplace safety programs. The form's structure reflects requirements from both federal legislation (such as the Canada Labour Code) and provincial occupational health and safety regulations, making it suitable for use across all Canadian jurisdictions while allowing for provincial-specific modifications as needed.
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1. Incident Identifier: Unique reference number, date, time, and location of the incident
2. Reporter Information: Name, position, and contact details of the person reporting the incident
3. Incident Classification: Type of incident (injury, near-miss, property damage, environmental, etc.) and severity level
4. Incident Details: Detailed description of what happened, including sequence of events and immediate actions taken
5. Persons Involved: Information about all parties involved, including witnesses, injured parties, and responding personnel
6. Immediate Response Actions: Steps taken immediately after the incident to secure the area and prevent further harm
7. Initial Assessment: Preliminary evaluation of damages, injuries, and immediate risks
8. Notifications Made: List of authorities, management, and other parties notified of the incident
9. Corrective Actions: Immediate and short-term actions taken to address the hazard
10. Sign-off Section: Signatures of reporter, supervisor, and safety representative with dates
1. Environmental Impact: Required when incident involves environmental spills, emissions, or natural resource damage
2. Equipment/Property Damage: Used when incident involves damage to equipment, vehicles, or facilities
3. Medical Response Details: Required when incident involves injuries or health-related issues
4. Chemical/Hazardous Materials: Required for incidents involving dangerous substances or WHMIS-controlled products
5. Security Breach Details: Used when incident involves security violations or unauthorized access
6. Production Impact Assessment: Required when incident affects operational capabilities or production
7. Third Party Involvement: Used when contractors, visitors, or public are involved in the incident
8. Media Communications Log: Required when incident has attracted or may attract media attention
1. Incident Scene Diagram: Template for sketching the incident scene and relevant details
2. Witness Statement Forms: Standard forms for collecting detailed witness accounts
3. Photo Log: Template for documenting and cataloging incident scene photographs
4. Risk Assessment Matrix: Guide for evaluating incident severity and probability
5. Emergency Contact List: List of emergency contacts and reporting authorities
6. Injury Classification Guide: Reference guide for categorizing types and severity of injuries
7. Investigation Checklist: Systematic checklist for ensuring thorough incident investigation
8. Regulatory Reporting Requirements: Summary of reporting obligations based on incident type
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