

Date Approved: August 26 2015
                    				Date Reviewed/Amended: November 16 2015
| Was an employee injured as a result of this incident? | Yes | Regulation 4310-31 WorkSafe BC Reporting and Investigation | ||
| Did the incident involve threat or violence toward an employee? | Yes | Regulation 4310-30 Protection of Employees from Violence in the Workplace. | ||
| Was a student or member of the public injured as a result of this incident? | Yes | Regulation 4310-42 Injuries to Students and Member of the Public. | ||
| Was there damage to property (buildings, vehicles, equipment)? | Yes | Regulation 4310-43 Property and Vehicle Damage | ||
| Was ther a near miss for injury or property damage? | Yes | Regulation 4310-44 Near Misses | 
Note: An incident may result in a "Yes" answer to more than one question, resulting in more than one investigation form being completed.
REFERENCES
                            
                           
                           		
                                		4310 -  - Occupational Health and Safety Policy
                                        
                           
                           		
                                		4310-41 -  - Worksafe BC Injury Reporting and Investigation
                                        
                           
                           		
                                		4310-43 -  - Property and Vehicle Damage Regulation
                                        
                           
                           		
                                		4310-44 -  - Near Misses Regulation
                                        
                           
                           		
                                		4330-10  -  - Protection of Employees from Violence in the Workplace
                                        
                           
                           		
                                		4310-42 -  - Injuries to Students and Members of the Public