Incident Report – TTI Employee Resource

Instructions Follow up with the Safety Manager, Jerome at (470) 877-5133 or Operational Manager, Dichunta at (478) 331-9386, or call the main dispacth line at (404) 797-9676 within 1 hour of the incident depending on urgency.
Date of Incident *
Time of Incident *HHMM
Email
Name of Injured Person: *
DOB
Type of Injury?
Gender
MaleFemale
Address *
Location of incidentStreet AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Phone
Who was the injured person? *
EmployeeMotoristOther
Details of the Incident: *
Injury requires physician/hospital visit?
YesNo
Name of physician/hospital and address
Physician/hospital phone number:
Select
NO medical attention was desired and/or required.
Signature *CONFIRM by typing you name
File Upload Upload any documentation (i.e. pictures, statements, police report etc.) that may be relevant.