Report an incident · Health and Safety Application

Tiger Machining

Incident & injury report

Use this form to report any injury, near miss, or hazard. Leaving your name blank submits it anonymously — it still reaches the safety team.

Date Time Site Location / area Type Severity

What happened? Anyone injured? (name / body part) Immediate action taken

Witnesses Supervisor notified? Name of supervisor notified Reported to WCB? (if medical aid) WCB claim / case number

Your name (optional — leave blank to stay anonymous)

Signature of person reporting

Sign below with your mouse or finger (optional for anonymous reports).