Incident Information
Date of Incident
Time of Incident
Location (Banquet Hall Name/Room)
Employee Information
Name
Job Title
Supervisor Name
Accident Details
Description of Accident
Cause of Accident (if known)
Equipment Involved (if any)
Injuries Sustained
Witness Information
Witness Name(s)
Witness Statement(s)
Response & Follow-Up
Immediate Actions Taken
Further Recommendations or Corrective Actions
Reporting
Report Completed By
Date