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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

Is there any plant/equipment involved in the incident?

Is there any vehicle involved in the incident?

Brief details of the incident

Incident Photos

IMMEDIATE ACTIONS TAKEN

Is first aid given to the injured?

Emergency services are contacted?

DETAILS OF WITNESS TO THE INCIDENT

Name

Position

Employer

Mobile No.

Valid Emirates ID

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.