2nd Form 9001 – Simplify Compliance

What is the name of your organization?

Where did the incident happen? (Provide a general location Insert address here] (copy)

When did the incident occur? (Approximate date and time; e.g., “[Insert date and time here]”.)

What type of incident was it? (Examples: Slip/fall, equipment failure, minor injury, etc. Keep it general.)

Was there any immediate danger or hazard that required an urgent response? (Yes/No; if yes, briefly describe the nature of the hazard.)

Did this incident result in any injuries, and if so, how severe? (General description only, e.g., “Minor cut,” “Bruise,” “No injuries reported.”)

Did the incident cause any damage to property or equipment? (General description, e.g., “Broken chair,” “Damaged door,” “No damage.”)

Who discovered or first noticed the incident? (Use roles/titles, e.g., “[Insert role/title here, such as Supervisor or Staff Member].”)

Were any immediate actions taken? (Examples: Turned off power, applied first aid, contacted security, etc.)

it? first response?

Is there any important detail that might help explain why the incident happened? (Short description, e.g., “Floor was wet,” “Equipment malfunction,” “Weather conditions.”)