OSBN Incident Report Form
Have you or a colleague
been involved in an incident
which resulted in an injury in an OSBN facility?
Report it now
 
What is your full name?

 
What is the full name of the person injured? *

 
Where did this incident take place? *

 
Where were they injured? *









 
How badly does this injury affect their ability to work?

 
How many people witnessed the incident?







 
What was the nature of the incident?

Provide as much detail as you can. Include the time and location of the incident.
 
Have steps been taken to reduce the chances of this happening again? *



 
Please review your report:


Name of reporter: {{answer_6277433}}
Reporter's email address: {{answer_6277435}}

Name of person injured: {{answer_6277434}}
Location of injury: {{answer_6277436}}
Severity of injury: {{answer_6277438}}/8
No. of witnesses: {{answer_6277439}}

Incident details:
{{answer_6277440}}

Have steps been taken to reduce the chances of this happening again?
{{answer_6277437}}
Thank you for reporting this incident.
We will now see if what further steps need to be taken.
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