Electrical Hazard Incident Report
Site Details
Project Name
Site Location
Date of Incident
Time of Incident
Person(s) Involved
Name
Job Title / Role
Contact Information
Incident Details
Specific Location of Incident
Description of Incident
Equipment / Materials Involved
Nature of Electrical Hazard
Electric shock
Arc flash
Fire
Exposed wires
Other
Was There Any Injury?
No
Yes
If Yes, Describe Injury and First Aid Given
Immediate Actions Taken
Actions Taken to Control Hazard
Personnel/Supervisor Notified
Investigation
Probable Cause of Incident
Preventive Measures Recommended
Report Prepared By
Name
Date