Incident Report Form & Submission Timeline
Mandatory form for reporting all workplace incidents, near-misses, and injuries. Must be completed and submitted to the safety office within 24 hours per WorkSafeBC Part 3 and OSHA 1904. This log captures root cause, corrective actions, and verifies chain of custody.
This Incident Report Form and Submission Timeline ensures every workplace injury, equipment damage, chemical exposure, near-miss, or fire is documented within the regulatory 24-hour window. The form captures root cause classification (human factors, mechanical failure, environmental), immediate corrective actions, and supervisory sign-off — creating a defendable chain of custody for WorkSafeBC, OSHA, and internal EHS audits. A designated safety officer must log each report in the master incident register within one business day of receipt.
- Secure the incident area and activate emergency response if required (first aid, fire suppression, evacuation). Do not disturb the scene until preliminary documentation is complete.
- All personnel entering the incident zone must wear appropriate PPE: hard hat, safety glasses, hi-vis vest, steel-toed boots, and gloves. Add respiratory or chemical protection if exposure is suspected.
- Notify the site supervisor or safety manager within 1 hour of the incident. Verbal notification is accepted — this form must follow within 24 hours.
Incident Classification & Compliance Matrix
| Status (P/F) | Checklist Item / Hazard | Compliance Standard | Action Required / Notes |
|---|---|---|---|
| [ ] Pass [ ] Fail | Incident location & time recorded with zone/machine ID | WorkSafeBC 3.5 / OSHA 1904.29 | _________________________ |
| [ ] Pass [ ] Fail | Involved persons identified (employees, contractors, visitors) | OHS Reg 33.1 / EPA SARA | _________________________ |
| [ ] Pass [ ] Fail | Immediate cause & root cause classified (human, mechanical, environmental) | CSA Z1005 / ISO 45001 | _________________________ |
| [ ] Pass [ ] Fail | Witness statements collected (written or voice recorded) | WSBC IRP / OSHA 1904.35 | _________________________ |
| [ ] Pass [ ] Fail | Corrective actions defined with owner & deadline | ISO 45001 10.2 / ANSI Z10 | _________________________ |
Incident / Corrective Action Log
| Date / Time | Item # | Safety Issue Identified | Corrective Action Taken | Assigned To |
|---|---|---|---|---|
| ___/___/_____ | 001 | _______________________________ | _______________________________ | _______ |
| ___/___/_____ | 002 | _______________________________ | _______________________________ | _______ |
| ___/___/_____ | 003 | _______________________________ | _______________________________ | _______ |
By signing below, the supervisor or designated competent person verifies that all incident details have been reviewed, root cause has been identified, and corrective actions have been assigned. This report has been submitted within the 24-hour timeline and logged in the master incident register.