The Employee Incident Report Form is a crucial document required under German workplace safety legislation, particularly the Arbeitsschutzgesetz (ArbSchG) and Social Code VII (SGB VII). It serves as the primary tool for documenting workplace incidents, accidents, and near-misses in accordance with German legal requirements. The form must be completed whenever an incident occurs that results in, or could have resulted in, injury, illness, or property damage. It captures essential information needed for statutory accident insurance (Berufsgenossenschaft), supports investigation processes, and helps identify preventive measures. The document ensures compliance with both workplace safety regulations and data protection requirements under GDPR and the Federal Data Protection Act (BDSG), while facilitating proper communication with relevant authorities and stakeholders.
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1. 1. General Information: Basic details including date, time, and location of incident, and identification of reporting person
2. 2. Employee Information: Details of affected employee(s) including name, employee ID, department, role, and contact information
3. 3. Incident Details: Comprehensive description of what happened, including sequence of events and immediate actions taken
4. 4. Injury/Damage Assessment: Description of any injuries sustained or property damage, including severity and immediate medical attention provided
5. 5. Witness Information: Names and contact details of any witnesses to the incident
6. 6. Environmental Conditions: Description of workplace conditions at time of incident (lighting, weather, equipment state, etc.)
7. 7. Immediate Response Actions: Details of emergency responses, first aid provided, or other immediate measures taken
8. 8. Data Protection Notice: GDPR-compliant information about how the reported data will be processed and stored
9. 9. Signatures: Space for signatures of reporting employee, supervisor, and safety officer
1. Equipment Involved: Detailed section about machinery or equipment involved in the incident, used when technical factors are relevant
2. Chemical Exposure: Specific section for incidents involving hazardous substances or chemical exposure
3. Third Party Involvement: Section for incidents involving external contractors, visitors, or members of the public
4. Works Council Notification: Additional section for cases requiring works council involvement as per BetrVG
5. Risk Assessment Update: Section for updating workplace risk assessment based on the incident
1. Appendix A: Body Map: Diagram for marking location and type of injuries
2. Appendix B: Photo Documentation: Template for attaching and describing incident scene photographs
3. Appendix C: Incident Scene Sketch: Template for drawing the incident scene layout
4. Schedule 1: Follow-up Actions: Checklist of required notifications and follow-up actions
5. Schedule 2: Document List: List of additional documents attached (medical reports, technical inspections, etc.)
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