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Construction Exposure Incident Reporting (CEIR) Form

Construction Exposure Incident Reporting (CEIR) Form 2025

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The Worker's Exposure Incident Reporting Form (CEIR) is a voluntary document designed for workers to report unexpected exposure incidents in the workplace involving dangerous chemicals or infectious substances. It aims to gather information about such incidents for potential future health issues. The form should be completed only if there is no lost time or illness resulting from the exposure. Employers are responsible for filing claims if medical treatment is required. The completed form can be submitted to the Workplace Safety and Insurance Board (WSIB) by mail or fax.

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Click ‘Get Form’ to open the Construction Exposure Incident Reporting (CEIR) Form in the editor.
Begin by filling out your personal information, including your last name, given name, address, and date of birth. Ensure accuracy for effective processing.
Next, provide your employer's information. Include the employer's name at the time of the incident and describe their business. This helps contextualize the exposure incident.
In the 'Details of Incident' section, select whether you experienced an exposure to infectious substances or chemical substances. Fill in the date and time of exposure accurately.
For infectious substances, check all applicable types of exposure and specify any suspected infectious agents. For chemical exposures, describe what occurred and list any chemicals involved.
Finally, sign the form electronically or print it for a handwritten signature before submitting it to your supervisor or directly to WSIB.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (91 Votes)
2016	4.1 Satisfied (55 Votes)

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How do I fill in an incident report form?

How to Write an Incident Report Gather the Basic Facts Immediately. Provide a Clear, Objective Narrative. Document Any Injuries, Damages, or Impact. Record Witness Statements. Note Notifications and Follow-Up Actions. Finalize with Signatures and Review.

How to write an incident report with examples?

A general staff incident report generally includes: Persons name and contact details. Incident Time, date, and site. Pertinent details about what happened. Kind of injury or damage. Name of witnesses. Safety measures taken Suggestions for prevention.

What is an incident report form?

An incident report form is used to provide a comprehensive record of any unwelcome or undesirable occurrence that occurs within the workplace environment. This includes such things as workplace accidents, hazardous material spills, safety violations or misconduct by employees.

What does a good incident report look like?

It provides a detailed account of what happened, who was involved, when and where it took place, it contains pictures of any physical evidence of injury or property damage, witness statements and maintenance records if needed, it identifies any causes or contributing factors and concludes with recommendations of

How to fill out an incident report form?

What to Include in an Incident Report General information. Setting or environment. Affected people. Injuries and the severity. Witnesses. Administered treatment. Property and equipment damages. Events.

What 6 points should be included in an incident report?

A: An effective incident report should include basic information (date, time, location, and reporters name), a detailed description of the incident, witness statements, evidence documentation, and actions taken.

What are the 5 rules of incident reporting?

What are the five rules of incident report writing? Timeliness: Always report the incident as soon as possible. Accuracy: Make sure all information provided is accurate and detailed. Completeness: Be thorough and provide all important details. Confidentiality: Handle sensitive and personal information carefully.

How to write an incident report for construction?

At a minimum, any incident report should include: Time and location of the incident. Description of the employees actions that led up to the event. Details about how the event actually occurred. Corrective action taken. Name, title, and contact information for the person who completed the report.

Construction Exposure Incident Reporting (CEIR) Form 2025

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