Shipboard Safety Incident Report
Date of Incident
Time of Incident
Location on Ship
Type of Incident
Injury
Equipment Damage
Fire/Explosion
Spill/Leak
Near Miss
Other
Persons Involved
Witnesses
Detailed Description of Incident
Immediate Action Taken
Equipment or Machinery Involved
Root Cause Analysis
Preventive Measures / Corrective Actions
Reported By
Date
Reviewed By
Date