ADD EMPLOYEE INCIDENT REPORT

IR NO.	DATE	EMPLOYEE	SUBJECT
No incident records loaded.

Status: Ready Total Records: 0

Incident Report No: Date Reported: Subject: Reported By: Position/Department: Contact No:

WHO IS THE PERSON(S) INVOLVED?

	Employee Involved	Position	Company

◀

▶

WHO IS / ARE THE POSSIBLE WITNESS(ES)?

	Witness Name	Position	Company

◀

▶

Prepared by: Reviewed by: Noted by:

What happened?

What physical evidence or document exist to corroborate your report?

How did you know the subject of the report? (Personal or First-hand information about it)

When did the incident happen? (Date/Time/Frequency)

Where did the incident happen?

Since when has this been happening?

How much is involved? Please provide an approximate figure.