Incident Report Form

Incident Details

What happened before and during the incident. When and where the incident occurred.

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Incident Details

Incident Title

Incident Classification(s)

Accident / Incident Type

Describe the incident

Potential For Serious Injury

WorkSafeBC defines a serious injury as any injury that results in a loss of consciousness or can reasonably be expected at the time of the incident to endanger life or cause permanent injury.

Did this incident involve a serious injury, or was there potential for a serious injury?

Yes No

Date and Time of Incident

Did the incident or injury occur during one event or over the course of more than one day?

One Event Over a Time Period

Is the cause of the incident or injury still ongoing?

Yes No

Date

Time

Start Date

End Date

People Involved in the Incident

Here you can enter all of the people who were involved in the incident.

Click the "Add Person" button below to add people to this incident.

Were there any witnesses of the incident?

Yes No

Records Must Be Complete For

The Report Writer

The Person(s) Directly Involved In the Incident

At least one witness of the incident

Bullying / Harassment

NOTE: Because this incident has been indicated as "Bullying / Harassment", the people entered into the below involved people record list will NOT be able to view this incident or receive notifications about it. In the below record list, please only enter the victims of the bullying / harassment, witnesses, or supervisors (if necessary). Do not enter the aggressors in this record list, they can be added on the previous tab.

Add Person

View / Edit	Name(s)	Involved Person Department	Injury Severity	Injury Type	Body Part	First-Aid	Sub-Unit	Public Involved Person Form	Involved Person Role	Involvement

Collateral Damage

Enter any property damage or environmental impact that occurred as part of the incident.

Property Damage

Add Property Damage

View / Edit	Asset Name	Asset Type	Cause of Damage/Loss	Description

Property Damage Section Not Required

This section is not required for this incident because property damage was not entered as an incident classification on the first tab

Environmental Impact

Add Environmental Impact

View / Edit	Cause of Environment Impact	Env - Type of Impact	Description

Environmental Impact Section Not Required

This section is not required for this incident because environmental impact was not entered as an incident classification on the first tab

Submit Your Form

Click Here To Submit

Once all of the required fields are completed, you can submit your form.

When you submit your form, notifications will be sent to the appropriate people for follow-up of the incident.

Your form has been automatically saved

Safety Portal

Incident ID 2990 (Incident Report Form)

Incident Details

Incident Details

Potential For Serious Injury

Date and Time of Incident

Location of Incident

Emergency Services Notification

SFU Campus Public Safety Report Information

Police Report Information

Fire Dept Report Information

Ambulance Report Information

Environmental Service Report Information

Supporting Documentation

Incident Reported By

Incident Classification

People Involved in the Incident

Records Must Be Complete For

Bullying / Harassment

Collateral Damage

Property Damage

Property Damage Section Not Required

Environmental Impact

Environmental Impact Section Not Required

Submit Your Form

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