The Health and Safety Incident Report Form is a crucial document required by Pakistani labor laws and workplace safety regulations for recording and reporting workplace incidents. It must be completed whenever an accident, near-miss, or hazardous occurrence takes place in the workplace. The form captures vital information including incident details, affected persons, witness accounts, and immediate actions taken, serving as an essential tool for incident investigation, risk management, and regulatory compliance. This document is particularly important for fulfilling reporting obligations under the Factories Act 1934, provincial safety regulations, and relevant labor laws, while also supporting insurance claims and worker compensation processes. The form should be readily available in all workplaces and completed as soon as possible after an incident occurs.
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1. Incident Identification: Basic details including date, time, location, and reference number of the incident
2. Reporter Details: Information about the person completing the form including name, position, contact details
3. Affected Person(s) Information: Details of all persons involved in or affected by the incident, including employees, contractors, visitors
4. Incident Details: Comprehensive description of what happened, including sequence of events and immediate actions taken
5. Type of Incident: Classification of incident (injury, near miss, property damage, environmental incident, etc.)
6. Severity Assessment: Assessment of incident severity including actual and potential consequences
7. Immediate Response Actions: Details of emergency response, first aid, or other immediate actions taken
8. Witness Information: Names and contact details of witnesses and their initial statements
9. Initial Investigation Findings: Preliminary findings about causes and contributing factors
10. Notifications Made: List of internal and external parties notified about the incident
1. Environmental Impact Assessment: Required when incident involves environmental aspects such as spills or emissions
2. Equipment/Property Damage Details: Used when incident involves damage to equipment, vehicles, or property
3. Medical Report Summary: Required when incident results in injury requiring medical attention
4. Security Incident Details: Used when incident involves security breaches or criminal activity
5. Chemical Exposure Information: Required for incidents involving hazardous substances or chemical exposure
6. Traffic Incident Details: Used for incidents involving vehicles or occurring on roads/parking areas
7. Contractor Involvement: Required when contracted workers are involved in the incident
1. Incident Scene Photographs: Photographic evidence of the incident scene, damage, or hazards
2. Sketch/Map of Incident Location: Diagram showing the location and layout where incident occurred
3. Risk Assessment Form: Standard risk assessment template to evaluate incident risks
4. Witness Statement Forms: Detailed witness statement templates and completed statements
5. Medical Certificates: Copies of any medical certificates or reports related to injuries
6. Equipment Inspection Reports: Related equipment inspection or maintenance records if relevant
7. Training Records: Relevant training records of involved personnel
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