Incident Report

Incident reports are not intended to be punitive in nature. Their purpose is to accurately document accidents, damages, or near misses in order to identify patterns, improve safety measures, and raise awareness where applicable. Completing an incident report helps ensure accountability and continuous improvement, not to assign blame or impose disciplinary action.

Incident reported by:

First Name

Last Name

Date of incident

YYYY

Time of incident

Hour

Minute

Second

Location of incident

What type of incident occured?

Injury - no medical attention required

Injury - medical attention was required

Damage (including misuse of equipment)

Safety Concern

Description of the incident

Staff members involved

Cynthia

Karyne

Kate

Kim

Other names of individuals involved and their role

Include any witnesses not employed by Pawsio

Actions Taken - Immediate Response

(first-aid, people notified, etc.)

Actions Taken - Follow up actions

(repairs, policy review, etc.)

Checkbox

I (the person filling the report) acknowledge that the information provided in this report is accurate and true to the best of my knowledge.