Electrical Shock Incident Report
(Wiring Installation)
Date of Incident
Time of Incident
Location
Reported By
Contact Number
Person(s) Involved
Job Title/Position
Company/Contractor (if applicable)
Description of Incident
Immediate Actions Taken
Description of Wiring Installation Work at Time of Incident
Type of Injury (if any)
First Aid/Medical Treatment Provided
Possible Causes
Preventive/Corrective Actions Suggested
Supervisor/Manager Name
Date