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HR Incident Report Form Template

An HR incident report was filed regarding an employee, Aldio L. Robison. The report did not provide any details about the incident itself and did not name any witnesses. The employee filing the report, Liezel F. Burias, affirmed that the information provided was true and correct. The HR department found the incident report to be valid but did not specify what type of action would be taken in response.

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May Zayas
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247 views1 page

HR Incident Report Form Template

An HR incident report was filed regarding an employee, Aldio L. Robison. The report did not provide any details about the incident itself and did not name any witnesses. The employee filing the report, Liezel F. Burias, affirmed that the information provided was true and correct. The HR department found the incident report to be valid but did not specify what type of action would be taken in response.

Uploaded by

May Zayas
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd

HUMAN RESOURCES INCIDENT

REPORT
INSTRUCTIONS: Use this reporting of incident that may fall as violation of HR Policies. For any Environment, Health and Safety related incidents,
use FM-EHS-04 EHS Incident Report.
EMPLOYEE : LIEZEL F. BURIAS IR NO :
DEPARTMENT : FLUENCE VILLANUEVA DATE :
IMMEDIATE HEAD :
A. INCIDENT DETAILS
Name/s of employee/s ALDIO L. ROBISON Date of Incident : Dec. 18, 2021
involved: Time of Incident
Location :

Description of the Incident:

Are there others who have witnessed this behavior or others who have experienced a similar concern or problem? If so,
please provide their name(s) and phone numbers.

I affirm and certify that all the information herein is true and correct to the best of my knowledge and belief.

LIEZEL F. BURIAS
Employee Signature

Please do not mark this portion. FOR HR USE ONLY.


B. HR ACTION
Is the reported incident valid?
X Yes (go to Part C.)
No, Incident Report is invalid. Please provide reasons/details.

C. TYPE OF ACTION (if reported Incident Report is valid)


Verbal Warning
Written Reprimand Date Issued :
Suspension, identify length of Date/s covered :
suspension
Dismissal Effectivity :
Others (please indicate sanctions imposed)

Prepared By : Noted By :

LIEZEL F. BURIAS
HRMD Project Manager

FM-HRMD-49 Page 1 of 1
Rev.1 | 02 March 2020

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