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Incident Report Submission Form

Version 1.2 - 06/11/2024

To submit your incident report, please complete this form. Ensure you have explicit permission from your organisation to share this information. By submitting, you acknowledge and agree to these terms. For any questions, contact us at [email protected].

Company name (optional)

Email (optional)

Required only if you might need a response.

Location (optional)

Date of event

Brief description

Detailed Incident Description

Describe what happened and how the incident unfolded.

Involved Parties

Mention the roles (not personal identities) of those involved, such as operators, site managers, etc.

Contributing Factors

Contributing Factors

Other

Other Details (if any)

Mitigation Strategies

Describe any corrective actions or preventive steps that can prevent similar incidents.

Upload Photos, Visual Evidence, or Safety Report File