| SL No. |
Ref No. |
IMId |
Incident Date |
ReportedBy |
Zone |
Unit |
Area |
Shift |
Incident Description |
Incident Type |
Injury Type |
Immediate action taken |
What assistant has been requested |
External agency involved |
News media coverage |
Repetition |
ChronologyofEvent |
Scoring Description |
Root Causes |
Incident Reason |
Body Part |
Incident cost |
Quality Score |
Cost |
findings |
Witness Description |
Detils of Description |
Reco Count |
Status |
Recommendations |
| # |
Recommended Actions |
Responsibility |
Target Date |
Recommendation Type |
Action Taken |
Attachment |
Status |
Pending At |
Pending Since |
#ParameterWeightage(Max)Marks
