Employee's Report of Injury Form - Free Download | Page 5
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Employee's Report of Injury Form Page 5
Employee
5
Step 4: How can future incidents be prevented
What changes do you suggest to prevent this incident/near miss from happening again
Stop this activity Guard the hazard Train the employee(s) Train the supervisor(s)
Redesign task steps Redesign work station Write a new policy/rule Enforce existing policy
Routinely inspect for the hazard Personal Protective Equipment Other: ____________________
What should be (or has been) done to carry out the suggestion(s) checked above
Description continued on attached sheets:
Step 5: Who completed and reviewed this form (Please Print)
Written by:
Department:
Title:
Date:
Names of investigation team members:
Reviewed by:
Title:
Date:
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