Report an Incident...

Please use the form below to report an Incident to Geotech Drilling Services Ltd. Please note that some info is 'required' and is noted as such.

 

Reporting Date:		Required		Client:		Required
				Project:		Required
Incident Date:		Required		Geotech Employee(s):		Required
Time:		Required		Employee(s) Phone:		Required
Location:		Required		Witness:		Required
Description:		Required		Other Witness(es):
				Witness Statements?		Yes    No
Incident Type:		Injury/Illness Property Damage Major Potential Near Miss		Immediate cause(s):
				Underlying cause(s):
				Corrective action(s):		Immediate   Interim   Final
IF INJURY/ILLNESS:				IF PROPERTY DAMAGE:
Shift:				Property Description:
Age:				Estimated Cost:
Occupation:				Actual/Potential Loss:
Experience:				Type of Loss:
Nature of Injury:		Object Equipment Substance inflicting Injury Damage		Description of Loss:
RISK POTENTIAL IF NOT CORRECTED:
Loss severity potential:		Major    Serious    Minor
Probable recurrence rate:		Frequent    Occasional    Rare				Thank you for your submission.

 

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