Incident / Injury Report

monthly18 Questions

Form Preview

This is an interactive preview of the inspection form. In the actual Mining Sentry app, field operators can complete these forms on mobile devices with offline support.

Incident / Injury Report

Inspection Type:General Inspection

Cadence:monthly

1. Notify Plant Management For Approvals (Provide Short Description)*

2. Fault Status*

Photo Required

3. Name*

4. Employee ID#*

5. Date of Birth*

6. Home Address*

7. Telephone #*

8. Company*

9. Job Title*

10. Department or Plant #*

11. Date of injury/incident*

12. Time of injury/incident*

13. Date injury/incident reported*

14. Name of person injury/incident reported to*

15. Name(s) of witness(es)*

16. Exact location where injury/incident took place*

17. Body part affected by injury/incident*

18. Describe in detail exactly how the injury/incident occurred*

Note: This is a preview of the inspection form. In the actual Mining Sentry application, operators can complete these forms on mobile devices, attach photos, and submit them for real-time tracking.

Features

Mobile & offline capable
Photo & video attachments
Real-time notifications
Customizable workflows
Compliance tracking

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