FD Quality Hub
Internal Use Only
Submit Incident / Near Miss Report
Report an incident, near miss, unsafe condition, or other safety event.
Report ID
Report Date
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Incident / Event Date
*
Time of Incident
Reported By
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Department
*
Location
*
Type of Report
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Select type...
Injury / Illness
Near Miss
Unsafe Condition
Unsafe Behavior
Property / Equipment Damage
Forklift / Dock Incident
First Aid Only
OSHA Recordable
Other
Description of What Happened
*
Was Anyone Injured?
Yes
No
Person Involved (if applicable)
Immediate Action Taken
Was Supervisor Notified?
Yes
No
Photos / Attachments
Upload File
Additional Notes
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