[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-252808-105":53,"doc-detail-252808-en":127},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":120,"head_meta":122,"extra_data":124,"updated_unix":126},105,"en","employee-incident-report","Employee Incident Report","","Employee Incident Report is a structured workplace form for collecting factual information about employee injuries or occupational illnesses. It gathers detailed employee and contact information, incident timing, location context, witness details, and a step-by-step description of events. The form captures incident type, causation (sudden event, gradual occurrence, occupational disease, or fatality), direct causes and corrective actions taken, and the nature of the injury. It also records medical attention, attachments, and whether WSIB claim steps apply, supporting investigation and statistical tracking.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/employee-incident-report/252808/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/employee-incident-report/252808.png","ImageObject",442,249,{"name":88,"@type":89},"Ben Jamin","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-27","2026-09-13",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",9,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"What information is required about the employee in this report?","Question",{"text":109,"@type":110},"The report requests the employee’s last name, first name, date of birth, address, city/town, province, postal code, division/department/unit, occupation at the time of injury, and contact numbers, along with employee ID/SIN.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"How is the incident type and causation determined?",{"text":114,"@type":110},"The form includes check options for the type of incident (e.g., struck/caught, overexertion, fall, slip/trip, motor vehicle accident) and a separate cause section to indicate whether it was sudden, gradually occurring, an occupational disease, or a fatality, plus direct causes.",{"name":116,"@type":107,"acceptedAnswer":117},"What does the report collect after the incident regarding corrections and medical attention?",{"text":118,"@type":110},"It records the corrective actions taken (planned and corrected dates), details of the injury (including body part and left/right side), whether prior similar issues existed, and the occupational health section covering whether medical attention was sought and which health services were visited, including attachments to the report.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},252808,1789262994,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":73,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":126,"read_time":9},2336478466772,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","Employee Incident Report \n\n| Emp loyee Information | Last Name\u003Cbr>| | | | | | | | | | | | | | | | | | | | | | |\u003Cbr>First Name Date of Birth (DD/MM/YY)\u003Cbr>| | | | | | | | | | | | | | | |/| | |/| | | | | | | | | | | Home Telephone No. | | | | -| | | | |(| | | |)\u003Cbr>Work Telephone No. | | | | -| | | | |(| | | |) Employee ID\\# / SIN | | | |-| | | |-| | | | | | | | | |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n| | Address\u003Cbr> City/Town Province Postal Code | | | || | | | | | | | | | | | | | | | | |\n| | Division/Dept./Unit Occupation at time of Injury | | | | | | | | Check: Full-time Casual\u003Cbr>Part-time Student | | | Years of Experience | | | | | Was the employee on the job when the injury occurred? (check)\u003Cbr> YES NO |\n| Descr ipt ion of Incident | Date of Incident (DD/MM/YY)\u003Cbr>| | |/| | |/| | |\u003Cbr>Time of day AM/PM | | Date Reported (DD/MM/YY)\u003Cbr>| | |/| | |/| | |\u003Cbr>Time of day AM/PM | | | | | | To whom was the incident reported? If report is delayed, please explain why. | | | | | |\n| | State the exact sequence of events leading up to the incident. Include an explanation of what the employee was doing.\u003Cbr> | | | | | | | | Did the accident happen on the employer’s premises?\u003Cbr>\u003Cbr> | | | | Identify the sizes, weights & types of equipment involved.\u003Cbr>Type of Incident (check one—definitions on reverse):\u003Cbr>1 Struck/Caught\u003Cbr>2 Overexertion\u003Cbr>3 Repetition\u003Cbr>4 Fire/Explosion\u003Cbr>5 Fall\u003Cbr>6 Harmful Substances/Environmental\u003Cbr>7 Assault\u003Cbr>8 Other\u003Cbr>9 Slip/Trip\u003Cbr>10 Motor Vehicle Accident | |\n| Witnesses | Names, positions, & phone numbers of witnesses or persons having knowledge of the incident. | | | | | | | | | | | | | |\n| Cause | Was the accident/illness:\u003Cbr>1 A Sudden, Specific Event/Occurrence? 2 Gradually Occurring Over Time? 3An Occupational Disease? 4A Fatality? | | | | | | | | | | | | | |\n| | Direct causes (check one – see reverse): 1 Basic causes (check one): 1 | | | | | Physical/Environmental 2\u003Cbr>Job factors 2 | | | | Personal\u003Cbr> Personal factors | | | Examples of Actions:\u003Cbr>1. Reinstruction of person involved\u003Cbr>2. Reassignment of person\u003Cbr>3. Order job safety analysis done\u003Cbr>4. Improve personal protective equipment\u003Cbr>5. Action to improve inspection\u003Cbr>6. Equipment repair or replacement\u003Cbr>7. Correction of congested area\u003Cbr>8. Installation of guard or safety device\u003Cbr>9. Actions to improve design/procedure\u003Cbr>10. Check with manufacturer\u003Cbr>11. Inform all department supervisors\u003Cbr>12. Discipline of persons involved\u003Cbr>13. Other: | |\n| Correction | Action(s) Taken CORRECTED PLANNED Date (DD/MM/YY)\u003Cbr>(check box) (check box)\u003Cbr>1 | | |/| | |/| | | 2 | | |/| | |/| | | 3 | | |/| | |/| | | 4 | | |/| | |/| | | 5 | | |/| | |/| | | 6 | | |/| | |/| | |\u003Cbr>7 | | |/| | |/| | | | | | | | | | | | | | | | |\n| Injury | Describe the illness or injury, part of body involved and specify left or right side. | | | | | | | | | | | | | |\n| | Are you aware of any prior similar or related problem, injury, or condition? If yes, please explain: | | | | | | | | | | | | | |\n| | No injury (check one)\u003Cbr>1 Hazardous situation | | | | | | Injury – No WSIB Claim (check one)\u003Cbr>1 First aid\u003Cbr>2 No aid | | | | | WSIB Claim Treatment Memorandum (check one)\u003Cbr>1 Health care (medical aid)\u003Cbr>2 Lost time | | |\n| Occupat iona l Health | Did employee seek medical attention? (check one) 1 No 2 Yes Did employee visit health service? (check one) 1 No 2 Yes Did employee visit emergency? (check one) 1 No 2 Yes If Yes, ER Physician’s Name Tel. No. (| | | |) | | | | -| | | | | | | | | | | | Did employee visit family physician? (check one) 1 No 2 Yes If Yes, Physician’s Name Tel. No. (| | | |) | | | | -| | | | |\u003Cbr>Physician’s\u003Cbr>Address | | | | | | |\n| | Will the employee undertake:(","cbCaimyh72ATYHVs","https://ap.wps.com/l/cbCaimyh72ATYHVs","pdf",150259,"English","# Employee Information\n## Incident Details\n## Witnesses and Cause\n## Corrections and Injury\n## Occupational Health\n## Signatures and Instructions","[{\"question\":\"What information is required about the employee in this report?\",\"answer\":\"The report requests the employee’s last name, first name, date of birth, address, city/town, province, postal code, division/department/unit, occupation at the time of injury, and contact numbers, along with employee ID/SIN.\"},{\"question\":\"How is the incident type and causation determined?\",\"answer\":\"The form includes check options for the type of incident (e.g., struck/caught, overexertion, fall, slip/trip, motor vehicle accident) and a separate cause section to indicate whether it was sudden, gradually occurring, an occupational disease, or a fatality, plus direct causes.\"},{\"question\":\"What does the report collect after the incident regarding corrections and medical attention?\",\"answer\":\"It records the corrective actions taken (planned and corrected dates), details of the injury (including body part and left/right side), whether prior similar issues existed, and the occupational health section covering whether medical attention was sought and which health services were visited, including attachments to the report.\"}]","Employee Incident Report | PDF"]