The Hazard Incident Report Form is a crucial document required under UAE workplace safety regulations, designed to document and track workplace incidents, accidents, and near-misses. This form must be completed whenever a workplace hazard, accident, or safety incident occurs, in compliance with UAE Federal Law No. 8 of 1980 and related safety regulations. It captures essential information including incident details, affected parties, immediate actions taken, witness statements, and preliminary investigation findings. The document serves multiple purposes: meeting legal reporting requirements, initiating internal investigations, documenting incidents for insurance purposes, and supporting workplace safety improvement initiatives. It is structured to align with both UAE-specific requirements and international safety standards, ensuring comprehensive incident documentation while facilitating efficient reporting to relevant authorities.
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1. Report Identification: Unique report reference number, date and time of report completion, and document classification
2. Incident Details: Date, time, location, and type of incident (near miss, accident, injury, property damage, environmental)
3. Reporter Information: Name, position, contact details, and department of the person reporting the incident
4. Incident Description: Detailed account of what happened, including sequence of events and immediate observations
5. Affected Parties: Details of all persons involved, injured, or affected by the incident
6. Immediate Actions Taken: Emergency response measures and immediate actions taken to control the situation
7. Witness Information: Names and contact details of witnesses, with brief statements
8. Risk Assessment: Initial assessment of incident severity and potential consequences
9. Initial Investigation Findings: Preliminary causes and contributing factors identified
10. Notifications Made: List of internal and external parties notified (management, authorities, emergency services)
1. Environmental Impact Assessment: Required when incident involves environmental damage or potential environmental risks
2. Equipment/Property Damage Details: Used when incident involves damage to equipment, vehicles, or property
3. Chemical/Hazardous Materials Information: Required when incident involves hazardous substances or chemical spills
4. Medical Treatment Details: To be completed when incident results in injury requiring medical attention
5. Free Zone Specific Information: Additional information required for incidents occurring within UAE Free Zones
6. Contractor/Third Party Details: Required when incident involves contractors or third-party personnel
1. Appendix A - Site Plan/Location Map: Marked diagram showing incident location and relevant surroundings
2. Appendix B - Photographic Evidence: Photos or visual documentation of the incident scene and damages
3. Appendix C - Witness Statement Forms: Standardized forms for collecting detailed witness accounts
4. Appendix D - Risk Matrix: Standard risk assessment matrix for incident classification
5. Appendix E - Regulatory Authority Notification Checklist: List of relevant authorities to be notified based on incident type
6. Appendix F - Emergency Contact Directory: List of emergency contacts and reporting channels
7. Appendix G - Investigation Follow-up Form: Template for documenting subsequent investigation findings and actions
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