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General • Inspections

Event Incident Report

Incident reports are a great way to track all incidents that occurred within your workspace. This procedure can help take down information to be used for legal activities or for internal talks to be able to prevent future incidents from occurring.
Footprint Center
02/05/2024

Event Incident Report

Incident reports are a great way to track all incidents that occurred within your workspace. This procedure can help take down information to be used for legal activities or for internal talks to be able to prevent future incidents from occurring.

    Checklist

    Event Name

    Date/ Time of Event

    Engineering Supervisor

    Engineering Supervisor

    Freight Elevator

    Freight Elevator #5 Operational (Check emergency gate closure)

    • Pass
    • Flag
    • Fail
    if the answer is "oneOf [FLAG,FAIL]"

    Event Issues

    Event Incident Issue

    Issue

    Photo of Issue

    Add or drag pictures

    Issue Resolved?

    • Pass
    • Flag
    • Fail

    Any other issue?

    • Yes
    • No
    • N / A
    if the answer is "oneOf [Yes]"

    Event Incident Issue #2

    Issue

    Photo of Issue

    Add or drag pictures

    Issue Resolved?

    • Pass
    • Flag
    • Fail

    Any other issue?

    • Yes
    • No
    • N / A
    if the answer is "oneOf [Yes]"

    Event Incident Issue #3

    Issue

    Photo of Issue

    Add or drag pictures

    Issue Resolved?

    • Pass
    • Flag
    • Fail

    Any other issue?

    • Yes
    • No
    • N / A
    if the answer is "oneOf [Yes]"

    Event Incident Issue #4

    Issue

    Photo of Issue

    Add or drag pictures

    Issue Resolved?

    • Pass
    • Flag
    • Fail

    Any other issue?

    • Yes
    • No
    • N / A
    if the answer is "oneOf [Yes]"

    Event Incident Issue #5

    Issue

    Photo of Issue

    Add or drag pictures

    Issue Resolved?

    • Pass
    • Flag
    • Fail

    Any other issue?

    • Yes
    • No
    • N / A
    if the answer is "oneOf [Yes]"

    Event Incident Issue #6

    Issue

    Photo of Issue

    Add or drag pictures

    Issue Resolved?

    • Pass
    • Flag
    • Fail

    Any other issue?

    • Yes
    • No
    • N / A
    if the answer is "oneOf [Yes]"

    Event Incident Issue #7

    Issue

    Photo of Issue

    Add or drag pictures

    Issue Resolved?

    • Pass
    • Flag
    • Fail

    Any other issue?

    • Yes
    • No
    • N / A
    if the answer is "oneOf [Yes]"

    Event Incident Issue #8

    Issue

    Photo of Issue

    Add or drag pictures

    Issue Resolved?

    • Pass
    • Flag
    • Fail

    Any other issue?

    • Yes
    • No
    • N / A
    if the answer is "oneOf [Yes]"

    Event Incident Issue #9

    Issue

    Photo of Issue

    Add or drag pictures

    Issue Resolved?

    • Pass
    • Flag
    • Fail

    Any other issue?

    • Yes
    • No
    • N / A
    if the answer is "oneOf [Yes]"

    Event Incident Issue #10

    Issue

    Photo of Issue

    Add or drag pictures

    Issue Resolved?

    • Pass
    • Flag
    • Fail

    Any other issue?

    • Yes
    • No
    • N / A
    if the answer is "oneOf [Yes]"

    Event Incident Issue #11

    Issue

    Photo of Issue

    Add or drag pictures

    Issue Resolved?

    • Pass
    • Flag
    • Fail

    Any other issue?

    • Yes
    • No
    • N / A
    if the answer is "oneOf [Yes]"

    Event Incident Issue #12

    Issue

    Photo of Issue

    Add or drag pictures

    Issue Resolved?

    • Pass
    • Flag
    • Fail

    Any other issue?

    • Yes
    • No
    • N / A
    if the answer is "oneOf [Yes]"

    Event Incident Issue #13

    Issue

    Photo of Issue

    Add or drag pictures

    Issue Resolved?

    • Pass
    • Flag
    • Fail

    Any other issue?

    • Yes
    • No
    • N / A
    if the answer is "oneOf [Yes]"

    Event Incident Issue #14

    Issue

    Photo of Issue

    Add or drag pictures

    Issue Resolved?

    • Pass
    • Flag
    • Fail

    Any other issue?

    • Yes
    • No
    • N / A
    if the answer is "oneOf [Yes]"

    Event Incident Issue #15

    Issue

    Photo of Issue

    Add or drag pictures

    Issue Resolved?

    • Pass
    • Flag
    • Fail

    Any other issue?

    • Yes
    • No
    • N / A
    if the answer is "oneOf [Yes]"

    Event Incident Issue #16

    Issue

    Photo of Issue

    Add or drag pictures

    Issue Resolved?

    • Pass
    • Flag
    • Fail

    Any other issue?

    • Yes
    • No
    • N / A
    if the answer is "oneOf [Yes]"

    Event Incident Issue #17

    Issue

    Photo of Issue

    Add or drag pictures

    Issue Resolved?

    • Pass
    • Flag
    • Fail

    Any other issue?

    • Yes
    • No
    • N / A
    if the answer is "oneOf [Yes]"

    Event Incident Issue #18

    Issue

    Photo of Issue

    Add or drag pictures

    Issue Resolved?

    • Pass
    • Flag
    • Fail

    Any other issue?

    • Yes
    • No
    • N / A
    if the answer is "oneOf [Yes]"

    Event Incident Issue #19

    Issue

    Photo of Issue

    Add or drag pictures

    Issue Resolved?

    • Pass
    • Flag
    • Fail

    Any other issue?

    • Yes
    • No
    • N / A
    if the answer is "oneOf [Yes]"

    Event Incident Issue #20

    Issue

    Photo of Issue

    Add or drag pictures

    Issue Resolved?

    • Pass
    • Flag
    • Fail

    Any other issue?

    • Yes
    • No
    • N / A
    if the answer is "oneOf [Yes]"

    Event Incident Issue #21

    Issue

    Photo of Issue

    Add or drag pictures

    Issue Resolved?

    • Pass
    • Flag
    • Fail

    Any other issue?

    • Yes
    • No
    • N / A
    if the answer is "oneOf [Yes]"

    Event Incident Issue #22

    Issue

    Photo of Issue

    Add or drag pictures

    Issue Resolved?

    • Pass
    • Flag
    • Fail

    Any other issue?

    • Yes
    • No
    • N / A
    if the answer is "oneOf [Yes]"

    Event Incident Issue #23

    Issue

    Photo of Issue

    Add or drag pictures

    Issue Resolved?

    • Pass
    • Flag
    • Fail

    Any other issue?

    • Yes
    • No
    • N / A
    if the answer is "oneOf [Yes]"

    Event Incident Issue #24

    Issue

    Photo of Issue

    Add or drag pictures

    Issue Resolved?

    • Pass
    • Flag
    • Fail

    Any other issue?

    • Yes
    • No
    • N / A
    if the answer is "oneOf [Yes]"

    Event Incident Issue #25

    Issue

    Photo of Issue

    Add or drag pictures

    Issue Resolved?

    • Pass
    • Flag
    • Fail

    Any other issue?

    • Yes
    • No
    • N / A
    if the answer is "oneOf [Yes]"

    All Additional Issues

    Photo of Additional Issues

    Add or drag pictures

    Additional Issues Resolved?

    • Pass
    • Flag
    • Fail

    Checklist Completion

    Conclusion Of Event

    Provide Count of Extension Cords Used

    Provide Count of Extension Cords Picked up

    Provide Count for ADA Cable Covers & Ramps

    Meter name
    Unit

    Provide Count for Orange & Yellow Cable Covers

    Meter name
    Unit

    Provide Count for CO2 Extinguishers Picked Up

    Check Event Sheet on Amount

    Meter name
    Unit

    Provide Count for Extinguishers Picked Up

    Meter name
    Unit

    Checklist Completion

    Engineer

    Engineer's Signature

    Click here to sign
Source: Footprint Center (Community Member)

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