Injury or Illness Incident Report

The Injury or Illness Incident Report is to be completed by the Job Supervisor whenever there is an injury on the job site of sufficient severity to warrant filing this report.

The filing of the report is at the discretion of the Job Supervisor. However, it is recommended that an injury report be filed for each reported injury incident, no matter the severity. It is better to file a report and not need it than to need a report and not have filed it.

No information you provide on this form is stored by this or any other website. When submitted, form responses are sent to the email addresses provided and then deleted.
IF YOU WISH TO RETAIN THE INFORMATION YOU HAVE ENTERED, ADD AN EMAIL ADDRESS AND SUBMIT.

When the “Send Inspection Report” button is selected, an email with all the information in this Inspection Report will be sent to the “Builder email” address of the Company Representative completing this report and to the “Subcontractor email” address and “Copy to” addresses if provided.

Injury or Illness Incident Report

Injury or Illness Incident Report

The Injury or Illness Incident Report is to be completed by the Job Supervisor whenever there is an injury on the job site of sufficient severity to warrant filing this report.

No information you provide on this form is stored by this or any other website. When submitted, form responses are sent to the email addresses provided and then deleted.
IF YOU WISH TO RETAIN THE INFORMATION YOU HAVE ENTERED, ADD AN EMAIL ADDRESS AND SUBMIT.

INJURY OR ILLNESS INCIDENT REPORT

We are issuing an Injury or Illness Incident Report

The following information relates to the affected person

The injury or illness incident

Treatment or First Aid provided

Follow-Up

Note 1

Note 2

Note 3

Injury or Illness Incident Report

Injury or Illness Incident Report

The Injury or Illness Incident Report is to be completed by the Job Supervisor whenever there is an injury on the job site of sufficient severity to warrant filing this report.

No information you provide on this form is stored by this or any other website. When submitted, form responses are sent to the email addresses provided and then deleted. IF YOU WISH TO RETAIN THE INFORMATION YOU HAVE ENTERED, ADD AN EMAIL ADDRESS AND SUBMIT.

INJURY OR ILLNESS INCIDENT REPORT

We are issuing an Injury or Illness Incident Report

The following information relates to the affected person

The injury or illness incident

Treatment or First Aid provided

Follow-Up

Note 1

Note 2

Note 3

No information you provide on this form is stored by this or any other website. When submitted, form responses are sent to the email addresses provided and then deleted.
IF YOU WISH TO RETAIN THE INFORMATION YOU HAVE ENTERED, ADD AN EMAIL ADDRESS AND SUBMIT.