Kitchen Burn Incident Report
Date of Incident
Time of Incident
Employee Name
Position
Location in Kitchen
Type of Burn
First Degree
Second Degree
Third Degree
Affected Body Part
Cause of Burn (e.g., hot oil, pan, oven, etc.)
Brief Description of How Incident Happened
First Aid Provided
Was Medical Attention Needed?
Yes
No
Witnesses (Names)
Manager/Supervisor Follow-up Actions
Manager/Supervisor Name
Report Completed Date