Scribd
Upload
158 views1 page

Incident Complaint Report Template

This incident report documents a complaint made on an unspecified date, including the supervisor notified, time, and name. The report records the signature of the person preparing it and allows space for supervisor comments, recommendations, corrective actions, and signatures of the administrator and person making the complaint. It also tracks whether the first report was sent and OSHA log number.

Uploaded by

Teff Quibod
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
158 views1 page

Incident Complaint Report Template

This incident report documents a complaint made on an unspecified date, including the supervisor notified, time, and name. The report records the signature of the person preparing it and allows space for supervisor comments, recommendations, corrective actions, and signatures of the administrator and person making the complaint. It also tracks whether the first report was sent and OSHA log number.

Uploaded by

Teff Quibod
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

INCIDENT/COMPLAINT REPORT

Incident Reported By: __________________________________ Date: ________________________


Supervisor Notified: _____ yes _____ no
Date: _________________ Time: _______________
Name of Supervisor: __________________________________________________________________
Signature and Title of Person Preparing Report: ______________________________ Date: _________
Supervisor Comments: ________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Supervisor Signature: ___________________________________________________ Date: ________
Recommendation: ___________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Corrective Action Taken/Follow-Up: (Things that have been or will be taken to prevent recurrence)
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Administrator Signature: __________________________________________________ Date: ________
Signature of Person making Complaint: ______________________________________ Date: ________
Job Title: ___________________________________________
First Report Sent: _____ yes _____ no Date: _______ OSHA 300 Log # : ______

You might also like