Laboratory Electrical Hazard Incident Report
Date of Incident
Time of Incident
Location (Lab Name/Room)
Person(s) Involved
Contact Information
Description of Incident
Type of Hazard
Electric shock
Burn
Spark/Arcing
Short circuit
Equipment failure
Other
Severity
Minor
Moderate
Severe
Immediate Action Taken
Witnesses
Reported By
Date Reported
Supervisor/Manager Notified
Corrective Actions/Recommendations