Electric shock incident report template
Short answer
An electric shock report names the equipment, the supply and whether anything was isolated or tested. It records how the person was contacted and what they felt, even if they say they’re fine. Download the PDF or Word template, or record the same fields by voice.
Writing up a electric shock
A shock that “didn’t seem like much” can still be serious. The person may feel fine for an hour. The report is written for the investigator and the doctor, which is why it records how the contact happened rather than how bad it looked.
Fields to capture
Electrical reports turn on state: what was live, what was off and who said so. These fields record state before injury.
- Equipment, board or circuit involved, and its label
- Supply type: single phase, three phase, extra-low voltage or DC
- Isolation state: locked, tagged, tested dead, or none
- How contact happened: tool, cable, panel, wet surface or overhead line
- Symptoms felt at the time and later, such as tingling, burns or a racing heart
- Protective equipment worn: gloves, mat or insulated tools
- Whether the supply was switched off after, and by whom
What a good record looks like
A good record is specific about what was touched and how. “Got a belt off the board” isn’t enough. It names the board, the circuit and what the person’s hand was on. It also logs whether the supply was isolated afterward, and who did it.
Where reports go wrong
People under-report shocks because they feel fine. The record then misses a delayed effect, such as a burn or an irregular heartbeat. Another gap is the equipment itself, which often goes back into service before anyone has written down what it was.
Serious injuries and the regulator
An electric shock can be serious even when the person walks away. The notifiable incidents page explains which events reach the regulator and gives each state’s number. Look at it early and ring the regulator if you’re unsure whether yours qualifies.
Where Haznote fits
Haznote records the voice note, the photo of the equipment and the time. The manager sees the report straight away and can confirm the category. The AI drafts and a person confirms. Haznote doesn’t decide whether an event is notifiable.
Download the form.
A free example to print or edit. It’s general information, not legal advice, and it asks for no email.
Plain answers.
What if the person says they’re fine?
Write the report anyway. Record what happened and let the symptoms section stay open for later.
Should the equipment be left alone?
Leave it as it is until the supervisor and the licensed person have looked at it, and photograph it before anyone touches it.
Is a tingle from a tool an incident?
It is a near miss at least. Report it so the tool gets tested.
Where this comes from.
This page describes how Haznote works. It makes no claims about the law, so it cites no regulator.
Record a electric shock by voice. A manager confirms it.
Run it on one site and see the first report land in the manager’s list.