Occupational Health Exposure Incident Reporting Template
Date of Incident
Time of Incident
Employee Name
Employee ID
Department/Unit
Job Title
Location of Incident
Type of Exposure
Biological
Chemical
Radiological
Physical
Other
Incident Description
Route of Exposure
Inhalation
Ingestion
Skin Contact
Mucous Membrane
Percutaneous (Needle Stick, Cut)
Other
PPE Used
Actions Taken
Witnesses (Name & Contact)
Reported To (Name/Title)
Date Reported
Employee Signature