Incident/ Hazard Report Form

Incident/ Hazard Report Form

Use this form to alert SAFE Centre management to any incidents involving personal injury, property damage, threatening behaviour, near misses, or potential hazards.
Date / Time of incident
In the case of physical injury AND property damage, please select “Physical injury.”
Select the general area
Name of person reporting the incident
We may need to contact you to follow-up on this report.
Include names of persons involved, any witnesses, and be as descriptive as you can. Mention any contributing factors.
if there was no property damage, please write “none”
Safety Actions taken
Please include any actions taken to make the area safe.