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•Identify whether this is a preliminary report, or a final report, (if no investigation will follow), by checking the appropriate box.
•Identify the department that will be affected by the loss.
•Identify the exact location of the loss occurrence (LSD, road, address, plan, block, etc.)
•Date and time of loss.
•The report should be completed by the affected person or his or her immediate supervisor, there are no limitations to who may report an incident.
•If the incident was caused by a CONTRACTOR'S actions, the contractor and company will be named.
•PERSONS INVOLVED, INJURED OR WITNESS TO LOSS should be named, with company/position and their role in the incident.
•Ambient weather at the time of loss should be very specific as it helps to paint a picture for those investigating and reviewing the incident.
•Identify light conditions, visibility, ambient temperature, wind speed and direction and if it were raining, snowing, etc. at the time of the incident.
•Incident Type - More than one incident type may be identified.
•When an injury has occurred, identify whether the casualty required:
•First aid - when casualty is treated outside medical facility, i.e., hospital, clinic, doctors’ office.
•Medical aid - when casualty must be treated (not just diagnosed) at a medical facility.
•DETAILED DESCRIPTION OF LOSS is the most critical part of any incident report. It must draw an accurate picture of the events leading up to and during the incident. It must be the WHAT happened, to WHOM, WHEN, WHERE, and HOW of the incident. All details should be listed in chronological order.
If a serious loss has occurred where more than one person was witness to the loss, it is important to collect written statements from all persons involved. This will assist the investigator in compiling and relaying the incident details in the description of loss.
The emergency response, if required, should also be reviewed in this section. Both successes and problems encountered during the response should be reviewed so that improvements may be made in future. Interim preventative measures should also be identified here.
•ESTIMATED COST: A preliminary report does not require this section to be completed, although, if possible, include an estimated cost of all losses incurred. Costing can be changed to represent a more accurate figure when an investigation is completed.
True replacement costs at current market value will be included for all equipment/materials damaged or destroyed; all clean-up costs; labour costs; the cost of lost product; and all persons' time involved in the investigation will be considered. None of these costs should ever be considered routine maintenance or the regular costs of doing business.