Hunter Incident Report

Report Submission Date(Required)

Involved Department(Required)

Hunter Division Supervisor / Title(Required)

Report information will be submitted to this contact.

Nature of Incident

Staff Injury

Vehicle Accident Report

Utility Strike Report

Equipment Damage Report

Reporting Staff(Required)

Your first & last name

Email Me Option

Email me a copy of this report

Reporting Staff Email(Required)

Incident Details

Date of Incident(Required)

Incident Occurance Time(Required)

Job Identification(Required)

Associated Job # or Project Name

Injured Party(Required)

First Last

Medical Attention

Medical Attention was administered

Crew members present(Required)

Please include first and last names of crew members and/or staff present at the time of this event.

Other 3rd Party Contacts Present or Communicated with(Required)

First & Last Name

Contact Phone

Contact Email

Affiliation

click "+" to add more contact entries

Location - Incident Address(Required)

Street Address City State

Incident Summary(Required)

What happened? Who was injured / What equipment was damaged? / Who's Network was damaged?

Action Taken / Response(Required)

How did we respond to this event? What actions were taken? Who was notified? How did we notify them?

NOTE: You have indicated that Medical Attention had been administered.
Be sure to include details of who administered medical attention (examples: on-site EMT, Ambulance personnel, etc ) or if taken to a medical facility, note the name of the facility that the injured party was taken to, and by whom.

Additional Notes

What other points should be mentioned regarding this incident?

Insights & Prevention

What incorrect assumptions were made? What kind of precautions could we take in the future to prevent this kind of occurrence? What did we learn from this event?

Photo & Video File Upload(Required)

Drop files here or

Max. file size: 12 MB.

Examples: provide images of the state of the incident location, images of specific damages, images of shared insurance card information (verify legibility), etc