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Health And Safety Incident Report Form

Health And Safety Incident Report Form Template for Saudi Arabia

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Key Requirements PROMPT example:

Health And Safety Incident Report Form

"I need a Health and Safety Incident Report Form for our construction company's Saudi operations that includes specific sections for equipment-related incidents and meets all MHRSD requirements, with additional focus on photo documentation and contractor involvement."

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Document background
The Health and Safety Incident Report Form is a crucial document required under Saudi Arabian workplace safety regulations and labor laws. It is designed to be used immediately following any workplace incident, accident, or near-miss situation, providing a structured format for documenting essential information required by authorities and stakeholders. The form ensures compliance with Saudi Labor Law (Royal Decree No. M/51) reporting requirements and facilitates proper incident investigation and follow-up. It must be completed for all workplace incidents ranging from minor injuries to serious accidents, and serves multiple purposes including legal compliance, insurance claims, risk management, and prevention of future incidents. The document supports organizations in meeting their obligations to report incidents to the Ministry of Human Resources and Social Development and other relevant authorities within mandated timeframes.
Suggested Sections

1. Incident Identification: Basic details including incident reference number, date, time, and location of the incident

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

3. Affected Person(s) Details: Information about the injured/affected person(s) including employee ID, job title, department

4. Incident Description: Detailed account of what happened, including the sequence of events and immediate actions taken

5. Injury/Damage Details: Specific information about the type and extent of injuries or damage sustained

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

7. Immediate Response Actions: Details of emergency response, first aid provided, or other immediate actions taken

8. Root Cause Analysis: Initial assessment of what caused the incident

9. Corrective Actions: Immediate and planned actions to prevent recurrence

10. Notifications Made: Record of notifications to relevant authorities, management, and other stakeholders

Optional Sections

1. Environmental Impact: For incidents involving environmental releases or impacts

2. Equipment/Machinery Involved: Detailed section for incidents involving machinery or equipment failure

3. Chemical Exposure Details: For incidents involving hazardous substances or chemical exposure

4. Third Party Involvement: When contractors, visitors, or members of the public are involved

5. Security Incident Details: For incidents involving security breaches or threats

6. Cost Impact Assessment: Preliminary assessment of financial impact and insurance implications

Suggested Schedules

1. Incident Scene Photographs: Photographic evidence of the incident scene and any damage

2. Medical Reports: Copies of any medical reports or first aid records

3. Witness Statements: Detailed written statements from witnesses

4. Risk Assessment Forms: Relevant risk assessments related to the activity involved

5. Equipment Inspection Records: Recent inspection records for any equipment involved

6. Training Records: Records showing relevant training of involved personnel

7. Incident Location Map/Diagram: Sketches or diagrams showing where the incident occurred

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

alex.den.21@genieai.co
Relevant legal definitions



































Clauses




















Relevant Industries

Manufacturing

Construction

Oil and Gas

Healthcare

Retail

Logistics and Transportation

Mining

Education

Hospitality

Chemical Industry

Food Processing

Pharmaceuticals

Utilities

Agricultural

Telecommunications

Relevant Teams

Health and Safety

Operations

Human Resources

Risk Management

Compliance

Security

Facilities Management

Emergency Response

Quality Control

Environmental Health

Maintenance

Production

Project Management

Relevant Roles

Health and Safety Manager

Operations Manager

Facility Manager

Site Supervisor

Department Head

Risk Management Officer

Compliance Officer

Human Resources Manager

Security Manager

Production Supervisor

Quality Control Manager

Environmental Health Officer

Maintenance Manager

Project Manager

Line Manager

Emergency Response Coordinator

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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