Incident Report - First Response Checklist

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Incident Report - First Response Checklist is a rapid gathering of the facts and collection of evidence about an incident, accident, or injury. Incident response is a course of action, not a lonely event. For the incident response to be fruitful, all teams must go by a synchronized and structured approach. There is important data collection to be done by the response program to effectively investigate the incident. The respected authority can conduct a complete investigation with this incident report.

General

Inspection area

Location

Area Id

Is the hand wash area clean?

Yes No Na

Does the area have soap and single-use napkins?

Yes No Na

Is sanitizing solution available in all areas?

Yes No Na

Is sanitizer concentration as per the need?

Yes No Na

Is hand sanitizer stocked up?

Yes No Na

Is hand wash direction displayed?

Yes No Na

Is hand washed properly?

Yes No Na

Is everyone wearing gloves?

Yes No Na

Are employees wearing a hair covering caps?

Yes No Na

Is the hand wash sink used for washing hands?

Yes No Na

Are nails trimmed and clean?

Yes No Na

Are employees wearing minimal accessories or jewelry?

Yes No Na

Are employees eating and drinking in the work area?

Yes No Na

Are employees wearing a proper uniforms?

Yes No Na

Are employees covering their faces while sneezing or coughing?

Yes No Na

Are all wearing proper PPE?

Yes No Na

Are injuries properly bandaged?

Yes No Na

Are proper industry shoes worn?

Yes No Na

Are eye protections worn if necessary?

Yes No Na

Are industry gloves worn when dealing with heavy items?

Yes No Na

Sign off

Employee interviewed

Supervisor of the unit -name

Supervisor of the unit -signature

SIGNATURE

Date

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Incident Report - First Response Checklist

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