What Ability – Incident ReportBack up - Incident Form Date of incident MM slash DD slash YYYY Time of incident : Hours Minutes AMPM Short description of incident / near miss*Area where incident / near miss occurred*Name of injured person (if relevant)Injury sustained (if relevant)Name of person who reported incident*Date of report* MM slash DD slash YYYY Name of person completing this form* First Last Telephone numberWitness Name and Contact Number*What preventative action could have been taken? Why was this action not taken?How much experience did the employee have in the task/s that was being performed when the accident / incident occurred? What training has been provided?What is the chance of the accident / incident occurring again?Briefly describe what happened including the sequence of events, investigate scene of incident or near miss; conditions present at time of incident; what was involved, what activity (if any) was taking place prior and at time of incident. What hazards was the worker exposed to? What hazards may have contributed to the incident occurring? (Attach photos below if available)File/photo upload Drop files here or Select filesMax. file size: 64 MB.