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Sample Form: گزارش حادثه HSE

ثبت فوری حوادث و شبه‌حوادث ایمنی: محل دقیق روی نقشه، شدت، شرح ماجرا و مستندات تصویری.

10 questions · Free up to 50 responses a month

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About this template

“گزارش حادثه HSE” has 10 questions; 8 are required and 2 optional. Question types: Short text (1), Mobile number (1), Date and time (1), Segmented buttons (1), Multiple choice (1), Yes / No (1), Number (1), Map location (1), Long text (1), File upload (1). 10 ready-made options across 2 choice questions, all editable in the online version.

In the online version of this template

  • Mobile numbers are validated against the Iranian number format.
  • Dates are picked and stored on the Jalali (Persian) calendar.
  • Attached files are stored with the response.
Related:Online form builder

Questions in this template

  1. 1.

    نام گزارش‌دهنده *

    (Short text)
  2. 2.

    شماره تماس *

    (Mobile number)
  3. 3.

    زمان وقوع حادثه *

    (Date and time)
  4. 4.

    شدت حادثه *

    (Segmented buttons)
    • شبه‌حادثه
    • جزئی
    • جدی
    • بحرانی
  5. 5.

    نوع حادثه *

    (Multiple choice)
    • سقوط از ارتفاع
    • برق‌گرفتگی
    • حریق
    • برخورد با اجسام
    • مواد شیمیایی
    • حوادث وسایل نقلیه
  6. 6.

    آیا مصدومیت داشته است؟ *

    (Yes / No)
  7. 7.

    تعداد مصدومان

    (Number)
  8. 8.

    محل دقیق حادثه را روی نقشه مشخص کنید *

    (Map location)
  9. 9.

    شرح کامل حادثه *

    (Long text)
  10. 10.

    تصاویر محل حادثه

    (File upload)

Printable or online?

Printable version (Word & PDF)

  • For filling in on paper, signing and filing by hand
  • Edit the Word file any way you like
  • Collecting and typing up the answers is up to you
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Online version on Porsino

  • Answers are collected and organised automatically — no retyping
  • National ID, mobile number and dates are validated instantly
  • Ready-made reports and charts, plus Excel export in one click
  • Share a link or QR code — it works on mobile too
Build the online version for free

How do I use this template?

  1. Sign up for Porsino for free; no bank card needed.
  2. In the panel, open “Templates” and choose “گزارش حادثه HSE”.
  3. Change the questions as you like, publish the form and send the link.

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