Incident Report

Health, Safety & Environment (HSE)

⚠ All employees involved and witnesses must complete this form and submit to HSE within 48 hours of the incident.
Incident Report ID
1

Who Was Involved?

Enter your information and the names of anyone else involved or who witnessed the incident.

2

What Happened?

Describe exactly what happened, in order. Include as much detail as possible.

3

When Did It Happen?

4

Where Did It Happen?

Include the facility name and the specific location within the facility (e.g., Gonzales, washout bays).

5

Why Did It Happen?

Explain why you believe this happened. Example: "The hose burst when the truck was being unloaded."

6

Photo / File Evidence

Attach photos of the scene, damage, equipment, or any other evidence. You can take photos directly from your phone camera.

Tap to take a photo or choose files
JPG, PNG, PDF, DOC — max 5MB each, up to 5 files
7

Additional Information

Add anything else that helps paint a clear picture. The more detail, the better the report.

8

Signature

Sign here with finger or mouse
9

Report Delivery

This report (as a PDF) will be delivered to:

primary
CC

Add backup email addresses separated by commas.

A PDF report will be generated, emailed to HSE and to your email, and downloaded for your records.

✓

Report Submitted

Your incident report PDF has been emailed to HSE and a copy sent to your email.

Report ID:

A PDF copy has been downloaded to your device.

✗

Submission Failed

There was a problem sending your report. Your data has NOT been lost.

Check your internet connection and try again. If the problem persists, use the button below to download the PDF and email it manually.