Incident Report Form

Explosives Security

Industry Accident Report Form
SAFEX Incident Alert Notification

ISEE is a member of SAFEX INTERNATIONAL, which is dedicated to protecting people and property by pooling information about accidents which leads to a better understanding of the reason for accidents and helps members avoid similar events in the future. We strive to provide information about any accident or incident affecting safety or security involving the manufacture, storage, transport and distribution, use, disposal and recycling of commercial explosives products. The SAFEX Secretariat then shares that information with members. Accordingly, the information you report will be submitted directly to SAFEX for inclusion in their database. Those reporting are asked to also report the conclusions, recommendations and lessons learned from any subsequent formal investigations in order that others may benefit. Thank you for your participation.

Please fill out this form to submit your incident report.

Date of Incident:

Reported by (Originator's first/last name):

Originator's Phone Number:

Originator's Email Address:

Company Name: (Name of company that experienced the incident:

   Where did the Incident Occur?
   (Location of incident: plant name, city, state and country)

What Happened? (short description of incident)

What Material was Involved? (Type and approximate quantity of explosives involved)

What was the Impact of the Incident? (Casualties/Damage/Environmental/Health):

Will there be an Investigation? YesNo

If YES, will the Investigation be: Internal External Combination

Other: (Please provide any other relevant information)

ISEE | 30325 Bainbridge Road | Cleveland, OH 44139 USA| Tel: 440-349-4400 | Fax: 440-349-3788