SAGA Incident Form
1. Reported by
About you, the person filling out this record
Forename
*
Surname
*
Job title
*
Site
*
Ashford
Dartford
Sittingbourne
Tonbridge
Witham
Welham Green
Ipswich
Ipswich Van
Thurrock Truck
Thurrock Van
Norwich
E-mail
*
Date
*
-
Day
-
Month
Year
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2. Incident details
Type of incident
*
Please Select
Fire
Theft
Property damage
Environmental
Dangerous occurrence
Vandalism
Ill health
Near miss
Date of the incident
*
/
Day
/
Month
Year
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Time
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Incident location
*
Incident details (Describe what happened)
*
Equipment details
*
Action to avoid re-occurrence
*
Picture 1 (Optional)
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Picture 2 (Optional)
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Picture 3 (Optional)
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Submit
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