Free Incident Report Template 38Free Incident Report Template 38Free Incident Report Template 38
Download the document to the computer for easy use
There are more pages to preview,Read on

Employer Incident Investigation Report (EIIR)
Please refer to the companion quick guide for assistance completing the investigation and this form.

1.

Employer’s information

Employer’s name

(legal name and trade name)

     
WorkSafeBC account number

Operating location number

Employer’s head office address

     
City

Province

Postal code

Employer’s representative’s name

Phone number

(include area code)

Email address

     
2.

Injured persons

Last name

First name

Job title

a)

b)

c)

d)

3.

Place, date, and time of incident

Location where incident occurred

(street address or GPS coordinates)

     
City

(nearest)

     
Date of incident

Postal code