HSE INITIAL INCIDENT REPORT FORM Form Number: 2025/TS/QA/HS/069 Employee ID(Required)Employee Name(Required)Position Description(Required)Phone Number(Required)Department(Required)CEO Office Section(Required)EM Section(Required)Operations Section(Required)HR , ADMIN & IT Section(Required)HSE Section(Required)Finance Section(Required)TS Section(Required)COD Section(Required)INCIDENT REF. NO.(Required)1. GENERAL INFORMATION OF EMPLOYEE INVOLVEDCompany(Required)2. TIME AND LOCATION INFORMATION Exact Location(Required)Time Event Occurred(Required)Time Reported(Required)Date Reported(Required)Task At Time(Required)Injury(Required)Department(Required)Shift(Required)Reported by(Required)Damage(Required)3. ACCIDENT/INCIDENT DESCRIPTION BRIEF DESCRIPTION OF THE INCIDENT(Required)Relevant Information/Controls (Applicable Procedures, Operational Controls etc)(Required)First aid Measures(Required)4. REMARKS(Required)
