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Kennedy/Jenks Consultants <br /> Property Damage Incident Report Form <br /> This form should be used only for an incident resulting in property damage without injury to <br /> employees involved. Use the Injury/Illness Report Form to document employee injuries. Use the <br /> Near-Miss Report Form to document Near-Misses. <br /> Name(s of employee(s) involved: <br /> Time, Date, and Location where the incident occurred: <br /> Description of the incident: <br /> What was the employee doing when the incident occurred? <br /> What action, mechanism, or piece of equipment ma have directly contributed to the incident? <br /> E_ <br /> What other processes or items may have indirectly contributed to this incident? <br /> E_ <br /> If this incident occurred at a job site, was a site-specific safety plan prepared and approved? If so, please <br /> attach to this form. <br /> Detail any corrective actions taken. <br />