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Critical Incident Report Form Template for Philippines

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Key Requirements PROMPT example:

Critical Incident Report Form

"I need a Critical Incident Report Form for our manufacturing facility that focuses on machinery accidents and chemical spills, with specific sections for equipment damage assessment and environmental impact reporting, compliant with Philippine DOLE regulations."

Document background
The Critical Incident Report Form is an essential document required under Philippine law for documenting significant events that may impact an organization's operations, safety, or well-being of individuals. It is primarily used when serious accidents, near-misses, security breaches, or other critical events occur that require formal documentation and potential reporting to authorities. The form aligns with requirements set forth by the Department of Labor and Employment (DOLE), particularly under RA 11058 and its implementing rules. It captures crucial information including incident details, immediate response actions, witness accounts, and follow-up measures, serving as both a legal record and a tool for preventing future incidents. Organizations must maintain these reports as part of their compliance with Philippine occupational safety and health standards, while ensuring adherence to data privacy regulations.
Suggested Sections

1. Incident Identifier: Unique reference number, date, time, and location of the incident

2. Reporter Information: Details of the person completing the report including name, position, contact information, and relationship to the incident

3. Incident Description: Detailed account of what happened, including sequence of events, immediate causes, and contributing factors

4. Persons Involved: Information about all individuals involved, including victims, witnesses, and other relevant parties

5. Immediate Actions Taken: Description of immediate response actions, including emergency measures and notifications made

6. Injuries/Damage Assessment: Details of any injuries to persons or damage to property/equipment

7. Initial Risk Assessment: Evaluation of the severity and potential consequences of the incident

8. Immediate Notifications Made: List of authorities, management, or other parties notified of the incident

9. Follow-up Actions Required: Immediate and long-term actions needed to address the incident and prevent recurrence

Optional Sections

1. Medical Response Details: Used when incident involves injuries requiring medical attention, including treatment provided and healthcare facilities involved

2. Environmental Impact: Required when incident involves environmental hazards or damage

3. Equipment/Property Damage Details: Used when incident involves damage to physical assets or equipment

4. Security Breach Information: Required for incidents involving security violations or unauthorized access

5. Media/Public Relations Impact: Used when incident has potential public relations implications or media attention

6. Worker's Compensation Details: Required when incident involves employee injuries that may lead to compensation claims

7. Legal Implications: Used when incident may have legal consequences or require legal reporting

Suggested Schedules

1. Witness Statements: Forms and collected statements from witnesses to the incident

2. Photographic Evidence: Photos or visual documentation of the incident scene, damages, or injuries

3. Incident Scene Diagram: Sketches or diagrams showing the layout and relevant details of where the incident occurred

4. Supporting Documentation: Relevant certificates, licenses, maintenance records, or other documents related to the incident

5. Medical Reports: Copies of medical assessments or treatment records if applicable

6. Risk Assessment Forms: Completed risk assessment forms related to the activity during which the incident occurred

7. Investigation Checklist: Standard checklist for ensuring all necessary investigation steps are completed

Authors

Alex Denne

Head of Growth (Open Source Law) @ 黑料视频 | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Relevant legal definitions






























Clauses























Relevant Industries

Healthcare

Manufacturing

Construction

Education

Transportation

Hospitality

Mining

Energy

Retail

Financial Services

Information Technology

Logistics

Chemical Industry

Food and Beverage

Public Sector

Maritime

Relevant Teams

Operations

Health and Safety

Human Resources

Risk Management

Security

Quality Assurance

Compliance

Emergency Response

Facilities Management

Environmental Health

Legal

Medical Services

Senior Management

Relevant Roles

Safety Manager

Risk Management Officer

Department Supervisor

Facility Manager

Human Resources Director

Operations Manager

Security Officer

Quality Assurance Manager

Environmental Health and Safety Coordinator

Compliance Officer

Site Supervisor

Shift Leader

Department Head

Emergency Response Coordinator

Health and Safety Representative

Plant Manager

Project Manager

Chief Operating Officer

Industries







Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks, 聽Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination, 聽Severance Pay, Governing Law, Entire Agreemen

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