The Hazard Incident Report Form is a crucial document required under Philippine workplace safety regulations, specifically aligned with Republic Act No. 11058 and DOLE Department Order No. 198-18. This form must be completed whenever a workplace hazard is identified or an incident occurs that could affect worker safety, health, or well-being. It captures essential information including incident details, affected persons, immediate actions taken, and witness accounts. The document serves multiple purposes: ensuring regulatory compliance, initiating proper incident response, facilitating investigation processes, and contributing to organizational learning and accident prevention. It is particularly important for industries with significant safety risks and must be maintained as part of the organization's safety records for a period specified by Philippine law.
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1. Report Identification: Unique report ID, date and time of report submission, and type of report (initial/follow-up)
2. Incident Details: Date, time, and location of the incident, type of hazard/incident, and brief description of what occurred
3. Affected Persons: Information about individuals involved, including employees, contractors, or visitors affected by the incident
4. Incident Description: Detailed narrative of the incident, including sequence of events and immediate observable consequences
5. Immediate Actions Taken: Description of emergency response measures and immediate actions taken to control or minimize the hazard
6. Witness Information: Names and contact details of witnesses and their role in relation to the incident
7. Reporter Information: Details of the person completing the report, including name, position, and contact information
8. Supervisor Verification: Immediate supervisor's review and verification of the incident report
1. Medical Response Details: To be included when the incident resulted in injury or illness requiring medical attention
2. Environmental Impact: For incidents involving environmental releases or potential environmental damage
3. Equipment/Property Damage: Details of any damage to equipment, facilities, or property when applicable
4. Chemical/Hazardous Material Details: Specific section for incidents involving hazardous substances, including SDS references
5. Third Party Involvement: Information about any third parties involved in or affected by the incident
6. Production Impact Assessment: Details of how the incident affected operations and production, if applicable
7. Initial Root Cause Analysis: Preliminary assessment of factors contributing to the incident, if immediately apparent
1. Incident Scene Photographs: Photos documenting the incident scene, damage, or hazardous conditions
2. Sketch/Layout: Diagrams or sketches showing the incident location and relevant details
3. Witness Statements: Detailed written accounts from witnesses
4. Medical Reports: Copies of initial medical reports or first aid records if applicable
5. PPE Checklist: Documentation of personal protective equipment in use at the time of incident
6. Risk Assessment Form: Pre-existing risk assessment for the task/area where the incident occurred
7. Incident Classification Guide: Reference guide for categorizing the severity and type of incident
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