Incident Report without Injury

Name of Involved Employee*
Name of Onsite Supervisor*
Job Title*
Date of Incident*
Time of Incident*
Name of Person Reporting Incident*
Facility/Location and State*
Description of Incident: Include names of individuals involved, nature of the incident, and narrative of what occurred.*
Upload Documents
Drop files here or

Max. file size: 50 MB.
Upload supporting documents, if applicable
Name of Person Submitting Report*
Date of Report*
Internal Use Only:
Candidate Recruiter Name
Client Recruiter Name
Please note incident, all communication, and follow ups of this incident in Target Recruit, and print all possible documentation to put in personnel file with this report.

Internal Use Only: