Your Report

Please check what is suitable (multiple checks possible) / mandatory


AccidentIncidentHazardMandatoryVoluntarySuggestionOther

Description of the event or hazard / mandatory:

If known, reason why the event happened (root cause) / optional:

Action taken to manage the event (corrective action) or possible action to mitigate hazard / mandatory:

Suggestions to prevent this event in the future (preventive action) / mandatory:

Choose date of event or hazard / mandatory:

Name / optional

Mail-Address / optional