FINFROCK Incident Notification Form

Complete this form as soon as practical after an incident occurs which results in an accident, Injury, Illness, damage to property, or near miss. Relay this form to Safety and HR as soon as possible along with any witness statements and photographs.

Name and title of the person filling out the report
Contact information of the person filling out the report
Click or drag files to this area to upload. You can upload up to 10 files.

At the request and instruction of Finfrock’s legal counsel, Finfrock’s Executive Safety Committee and/or Finfrock’s Human Resource Department, acting as investigators for Finfrock’s legal counsel, the attached photo(s) and report(s) is/are being provided for the purposes of gathering facts and information for the obtaining of legal advice.

This notification will only be sent to the Safety Department. Safety will coordinate with other departments as needed.