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The Employee Incident Report Form is a crucial document required under Philippine labor law for documenting workplace accidents, injuries, near-misses, and other significant incidents that occur within the workplace. This form is mandated by various Philippine regulations, including the Labor Code, Occupational Safety and Health Standards, and Republic Act 11058. It serves multiple purposes: ensuring proper documentation for workers' compensation claims, maintaining compliance with safety regulations, identifying workplace hazards, and developing preventive measures. The form must be completed promptly after any workplace incident and requires input from various stakeholders including the affected employee, supervisors, and safety personnel. Its completion is essential for legal compliance, insurance purposes, and maintaining a safe working environment.

1. Incident Identification Details: Basic information including date, time, location of incident, and report completion date

2. Employee Information: Details of the affected employee including name, employee ID, department, job title, and immediate supervisor

3. Incident Description: Detailed account of what happened, including the sequence of events leading to the incident

4. Type of Incident: Classification of the incident (injury, near-miss, property damage, etc.) with specific categorization checkboxes

5. Witness Information: Names and contact details of any witnesses to the incident

6. Immediate Actions Taken: Description of immediate response actions taken following the incident

7. Medical Attention: Details of any first aid or medical treatment provided, including healthcare provider information if applicable

8. Supervisor's Assessment: Immediate supervisor's evaluation of the incident, including initial investigation findings

9. Root Cause Analysis: Identification of factors that contributed to the incident

10. Corrective Actions: Measures to be implemented to prevent similar incidents in the future

11. Signatures and Verification: Required signatures from employee, supervisor, HR representative, and safety officer