The Critical Incident Report Form is a crucial document required under German workplace safety regulations, specifically designed to comply with the Arbeitsschutzgesetz and DGUV requirements. It is implemented when significant workplace incidents, accidents, near-misses, or safety concerns occur that require formal documentation and investigation. The form ensures systematic collection of incident-related information, facilitates proper reporting to relevant authorities and insurance providers, and supports the organization's safety management system. It includes sections for incident details, affected parties, immediate actions taken, and follow-up measures, while maintaining compliance with GDPR requirements for handling personal information.
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1. Report Identification: Unique report ID, date and time of report creation, and classification of report urgency
2. Incident Details: Date, time, location, and type of incident
3. Persons Involved: Details of affected individuals, witnesses, and reporting person (in compliance with GDPR)
4. Incident Description: Detailed narrative of the incident, including sequence of events and immediate impact
5. Immediate Actions Taken: Emergency responses and immediate measures implemented to contain the situation
6. Impact Assessment: Evaluation of damage or harm to persons, property, or operations
7. Initial Root Cause Analysis: Preliminary assessment of factors contributing to the incident
8. Notification Record: List of authorities, stakeholders, and parties notified of the incident
9. Report Authorization: Signatures and details of persons completing and reviewing the report
1. Environmental Impact: Used when incident involves environmental hazards or contamination
2. Equipment/Asset Damage: Required when incident involves damage to machinery, tools, or facilities
3. Customer/Client Impact: Include when incident affects external stakeholders or service delivery
4. Media/Public Relations: Used for incidents with potential public visibility or media interest
5. Insurance Notification: Include when incident requires insurance claim submission
6. Union Representative Statement: Required when incident involves union members or workplace safety concerns
1. Photographic Evidence: Photos or visual documentation of the incident scene and damages
2. Witness Statements: Detailed accounts from witnesses (using standardized statement forms)
3. Medical Reports: Copies of relevant medical documentation if injuries occurred
4. Risk Assessment: Pre-existing risk assessment relevant to the incident area/activity
5. Equipment Inspection Records: Recent inspection records if equipment was involved
6. Incident Scene Diagram: Sketches or diagrams showing the incident location and relevant details
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