Incident Notification System,
“Don’t be blindsided, be on the “IN”.

“IN”, our new Incident Notification system. The purpose of this system is to ensure the appropriate personnel are informed of any incident within the company in a timely manner. It is important to ensure all incidents are reported.

Within 60 minutes of any incident occurring, an INS form must be submitted. Please fill out all the fields below.

An incident is an unplanned, undesired event that deters completion of a task and may cause injury, illness, property or environmental damage or a combination of these in varying degrees from minor to catastrophic. This would include both Client and in-house LCR’s.

Please Note
This information is for IN-HOUSE ONLY and is NOT a substitution for completing LCR / Investigation.

Additional Info
Please include any visits to site medical center. Submit WCB form (yellow or white) to Corporate HSE Advisor the following work day.

Date Reported
Date of Occurrence
Time of Occurrence
Supervisor
Submitted By
Company
Location of Occurrence
Worker’s Name and Position
Damage to Equipment (if applicable)
Environmental Damage (if applicable)
Is an LCR required for this incident?
Was D&A testing required as per company D&A policy?
Description
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