Incident Investigation Report

Topscan Inspections Limited — HSE Safety Management System

All workplace incidents must be reported within 24 hours. Provide as much detail as possible to assist the investigation.

Full Name

Occupation / Role

Department

Part of Body Injured

Nature of Injury

Object Inflicting Injury

Date of Occurrence

Time of Occurrence

Date Reported

Exact Location

Activity at Time of Incident

Person in Control

Description of Incident

Immediate Actions After Incident

Loss Severity

Recurrence Rate

First Aid Received?

Time Lost?

Recommended Actions / Controls

Reporting Supervisor

Reviewed By (HSE)

Submitted securely to the Topscan HSE Management System.