User	Guest
Full Address
Site	Construction Site ABC Manufacturing Facility Office Building
Incident Type	Accident Fatality Fire Hazard Injury Near-Miss Property Damage Slip & Fall Theft
Date Time
Description
Priority	Urgent High Medium Low
Injuries	Yes No
Weather Conditions	Please selectClearFogHailHeatIceRainSnowThunderstormWind
Follow Up Required	No Yes
Submitted By
Signature	Clear