it will help you , how to make incident report.

1. Incident Report
Particulars of incident:
Date:22 June 2018 Time:11:00am Location:K.D.A chowrangi
Type of incident (please circle below):
Injury ☑️ Illness Environmental Notifiable event Other:
Reported by: Shazaib Khan Phone:03343157546
Role in the event: husband Email: unknown
The injured person:
Name: Tehmina Shahzaib Address: B 72 block 7 North Karachi.
Age:28 Phone: 03444097510
Witness(s):
Name: traffic police Phone: unknown
Name: public Phone :unknown
Describe the incident: (space overleaf for diagram if needed)
According to Mr shazaib (her husband) “she was sited on the back seat of motor bike and we were so happy at
that time because we're invited for lunch by her parents and unfortunately the veil of my wife stuck in to the chain
beneath the motor bike and suddenly we both fell and strike to the road and footpath” at the time of incident
many people were present there and they help us to reached to the hospital.
Describe any illness or injury: What part of the body is affected and how?
Open wound frontal forehead and left leg and arm injured.
Describe any property damage: What damage was caused and how?
Motor bike is completely damage its headlight, break light, petrol tank and both mirrors were broken.
Analysis: What do you think caused or contributed to the incident?
The major cause of the incident was the lady veil which stucked into the chain of motor bike and now a day this
is become common cause of unwanted injuries.
Prevention: What action has been taken to prevent a reoccurrence?
Give proper instructions to the riders and travellers keep safety measures when they ride. Give instructions to
females especially according to sitting position and strict them to carry Unnecessary thing within their hands.
completed:
Treatment:
A & E Hospital:ziauddin hospital north campus Karachi. Doctor: Muhammad Sami.
Type of treatment provided:tetanus, pain killers were given on spot and bendage was performed recommended
x-ray of left arm.