Incident Investigation Report Please enable JavaScript in your browser to complete this form.Report of:InjuryIllnessSpillProperty DamageNear missProduct ContaminationEmployee Information *FirstLastDate & Time of IncidentDate & Time of IncidentJob TitleTime in PositionGeneral Description of IncidentSupervisor's InvestigationDescribe in detail what happenEquipment, machine, tool, etc., being used at the time of the incidentYesNoWas a post-incident substance abuse test performed on this employee?YesNoWitnessYesNoif yes, Whom?Was the accident/Injury due toLack of trainingWrong methodLack of/wrong equipmentUnsafe working conditionsUnsafe work practiceOther (please define)Corrective Action(s)Additional CommentsEmployee's Signature *Please type your full nameDateNameSubmit