INCIDENT ANALYSIS FORM - Texas Mutual Insurance Company 2025

1. Click ‘Get Form’ to open the INCIDENT ANALYSIS FORM in the editor.
2. Begin by entering today’s date and the date the incident was reported. Fill in your company name, department, supervisor's name, and contact number.
3. In the 'Name of Person Involved' section, provide the full name of the individual affected by the incident. Continue by filling out their sex, social security number, date of birth, and the date of the incident.
4. Specify the time and day of the incident along with its exact location. Indicate whether it occurred on employer’s premises and describe the job task being performed at that time.
5. Complete sections regarding injury details including part of body affected, nature of injury or illness, and any witnesses present during the incident.
6. Finally, document preventive measures taken to avoid future incidents and provide descriptions from both employee and supervisor perspectives.

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