Employee incident reporting
DO NOT USE FOR EMERGENCY REPORTING NEEDING A QUICK RESPONSE. For record-keeping purposes ONLY.
Use this form to document any incidents involving an employee. This may include reporting accidents, breakages, or injuries in the workplace, conflicts, resolutions, or recognitions. Reports may also be used to anonymously submit concerns without fear of reprisal or reprimand.
Teammates can also use the employee reports to highlight positive actions, praises, and commendations for their teammates. Please no anonymous "praise" reports to ensure no self-promoting. Any anonymous praise or recognition reports will be ignored.
Employee Incident Report
Date of Incident:
Time of Incident:
If the exact time the incident occurred is unknown, please select the best approximate time.
What are you reporting?
Jade Location:
PIC (Person In Charge):
Who is submitting the report?
Employee(s) Involved:
Please list everyone involved.
Incident Description:
Please describe what happened, any subsequent actions that happened, and if any actions are remaining to be done. If damage report, please make sure to include any pertinent information regarding costs, repairs, or replacements. If posting employee praise or special recognition report, make sure to indicate WHO is submitting the report. Employees are NOT to submit special recognitions for themselves.
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