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Supervisor Incident Report Form.xlsx 2026

The document is a Supervisor's Report of Incident form from Weber State University's Environmental Health & Safety department. It outlines the procedure for reporting incidents involving injuries, fatalities, property damage, or near-misses within 24 hours. The form collects information about the injured person, incident details, contributing factors, safety equipment usage, and preventive measures for future incidents. It also includes a section for injury treatment and supervisor's signature.

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Click ‘Get Form’ to open the Supervisor Incident Report Form.xlsx in our platform's editor.
Begin by filling out the 'Injured Person's Information' section. Enter the name, W#, and select the status of the individual involved in the incident.
Next, complete the 'Incident Information' section. Provide details such as the date, location, time of the incident, and a description of what task was being performed at that time.
Indicate the results of the incident by checking appropriate boxes for injury, fatality, property damage, or near-miss. Include witness names and their contact numbers if available.
In the 'Describe how the incident occurred' field, provide a detailed account of events leading up to the incident. Address contributing factors and whether safety equipment was provided and used.
If applicable, fill out the 'Injury Information' section detailing medical treatment received and any concerns regarding work-relatedness.
Finally, ensure that you sign and date in the 'Signature Section' before submitting your completed form back to WSU EH&S office.

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