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SafetyGrid Incident Investigation Request

About 5 minutes. Most answers are a tap. If you don't know something, choose "Not known" and keep going. We'll work with what you have. You can write in English, Spanish or Chinese, and choose the language of your report.

1. About you

Your job title

Work email

Company name (optional)

Company name on the report?

Send the report to

Report language

2. The incident

Date of incident

Type of site

What kind of incident?

How serious?

Serious incidents: OSHA must be notified within 24 hours of an in-patient hospitalization, amputation or loss of an eye, and within 8 hours of a fatality. Those investigations are quoted separately. SafetyGrid does not take fatality investigations; please contact your legal counsel.

3. What happened

Tell us what happened, in order

Example: Around 9:30 AM, a carpenter was installing ceiling grid from a 6 ft stepladder. He stepped onto the top step to reach. The ladder shifted and he fell to the floor, landing on his left wrist. The supervisor stopped work, gave first aid and took him to urgent care. The ladder was tagged out of service.

4. Quick questions

Records not handy? Choose "Not known." That's fine.

Job title of the person involved

Years in that role

Last trained on this task

Supervisor present?

Written procedure or pre-task plan?

Required PPE worn?

Condition of tools or equipment

Reported to OSHA or another agency?

5. Photos, statements and documents

Need statements? Have each person fill out our blank statement form, or use your own. A phone photo of each page works. Statements can be written in any language. Or text each worker or witness this link to give their statement on their phone, in English, Spanish or Chinese: https://tally.so/r/ja1lR4. Blank paper form: https://cdn.shopify.com/s/files/1/0788/3918/5639/files/SafetyGrid_Incident_Statement_Form.pdf

Upload photos, statements or documents

What does each file show?

Please blur faces and name badges, and leave out medical records. Prefer email? Send files to info@safetygridhq.com with your company name in the subject.

6. If we need more information

Sometimes a quick question gets the report right. Tell us who to ask and how to reach them. If we can't reach your contact in time, we finish the report with what we have and list any open questions at the end.

Who should we contact with questions?

A
B

How can we reach them? Choose all that work.

Which do they prefer?

A
B
C

Another way that works (optional)

Best time to reach them (optional)

A
B
C

Acknowledgment