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INCIDENT NOTIFICATION FORM
DETAILS OF PERSON REPORTING THIS INCIDENT
Name
*
Email ID
*
Mobile
*
Company Name
*
DETAILS OF INCIDENT
Date of Incident
*
Location of Incident (Plot No./Warehouse No.)
*
Time of Incident
*
Zone
*
Nature of Incident
*
Nature of Incident
Fatality
Injury
Property damage
Fire
Environmental disturbance
Others
Is there any plant/equipment involved in the incident?
*
Is there any vehicle involved in the incident?
*
Brief details of the incident
*
Incident Photos
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IMMEDIATE ACTIONS TAKEN
Is first aid given to the injured?
*
Emergency services are contacted?
*
INJURED PERSON DETAILS
Name
*
Mobile No.
*
Gender
*
Occupation
*
Age
*
Emirates ID
*
Click to choose a file or drag here
Accepts .pdf files
Click to choose a file or drag here
Accepts .pdf files
Click to choose a file or drag here
Accepts .pdf files
DETAILS OF WITNESS TO THE INCIDENT
Name
*
Position
*
Employer
*
Mobile No.
*
Valid Emirates ID
*
Click to choose a file or drag here
Accepts .pdf files
Click to choose a file or drag here
Accepts .pdf files
NOTES
RAKEZ HS&E department reserves the right to request additional information (if necessary).
By checking the "I accept" box and submitting this form , you confirm that all information provided is accurate and complete to the best of your knowledge. You understand that submitting false or misleading information may lead to potential legal consequences. RAKEZ (Ras Al Khaimah Economic Zone) reserves the right to verify submitted information, share it with relevant authorities as required by law, and use it for processing your request. You consent to receive communication from RAKEZ regarding your submission through the provided contact information.
*
By checking the "I accept" box and submitting this form , you confirm that all information provided is accurate and complete to the best of your knowledge. You understand that submitting false or misleading information may lead to potential legal consequences. RAKEZ (Ras Al Khaimah Economic Zone) reserves the right to verify submitted information, share it with relevant authorities as required by law, and use it for processing your request. You consent to receive communication from RAKEZ regarding your submission through the provided contact information.
I accept
