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report an incident
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edit profile
edit profile
edit profile
payroll
payroll
my timesheets
my timesheets
my attachments
WHS
assessment
report an incident
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WHS
assessment
report an incident
Incident/Accident
Report
Employee first name:
Employee surname:
Email address:
Position:
Date and time of incident:
Client company:
Supervisor name:
people2people consultant:
Where did the incident occur? e.g. desk, stairwell, etc.
Describe the incident:
Give details of the injury:
Suggestions to prevent this from occuring again:
Have you informed your supervisor?:
--None--
Yes
No
Have you returned to work?:
--None--
Yes
No
If yes, what date did you return?
If no, what date do you expect to return?
Do you require medical attention? If so, what?
Name and phone number of your doctor/hospital used: