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Incident Notification Form Template

The document outlines the procedure for reporting incidents within a project, requiring the Sub-Contractor to notify the Main Contractor within one hour and submit an Incident Notification Form within twenty-four hours. It includes sections for details such as the type of incident, date, time, location, persons involved, injuries, and treatments. There are also spaces for signatures of the reporter, agreement, and acknowledgment by relevant parties.

Uploaded by

Abdullah Aliemraan
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32 views1 page

Incident Notification Form Template

The document outlines the procedure for reporting incidents within a project, requiring the Sub-Contractor to notify the Main Contractor within one hour and submit an Incident Notification Form within twenty-four hours. It includes sections for details such as the type of incident, date, time, location, persons involved, injuries, and treatments. There are also spaces for signatures of the reporter, agreement, and acknowledgment by relevant parties.

Uploaded by

Abdullah Aliemraan
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

LOCATION:

NOTIFICATION NO:
Type of Incident

Date

Time

Exact Location

Activity Performed
During the Incident
Person Involved

Identification
Designation

Brief Description

Nature of Injury

Initial Treatment Given

Further Medical
Treatment (if require)
Immediate Action
Required

Note:

For all incident occurrences within the project, Sub-CONTRACTOR should inform MAIN CONTRACTOR
by messenger and/or phone call within one (1) hour and subsequently follow by this Incident Notification
Form within twenty-four (24) hours.

Reported by: Agreed by: Acknowledged by:

Name: Name: Name:


Position: Position: Position:

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