App Template - Incident Report

Report incidents with classification and potential severity, allow anonymous submissions, attach photos/audio and collect signatures for EHS follow-up

Incident Report 2024
Standard incident report based on the mutual safety template, with optional extra fields for richer context.

I. Incident Description

Worksite *
 
  Area
 
  Other location
 
  Incident type / detail
 
  What task was being performed?
 
  What risk was present?
 
  Describe what happened
 
  Additional details (optional) – Audio note
Audio capture from the app

II. Incident Classification

  Incident classification
 
  Classification detail
 

III. Potentiality (Pre-assessment)

  Potentiality
 

IV. Reporter Details

  Anonymous?
◯ Yes
◯ No
  Full name
 
  ID number (RUT)
 
  Role / Position
 
  Signature
Signature pad (app)

V. Photo Evidence

  Photo evidence
Photo upload area (app)
Save Draft
Submit