Report Incident

Please fill all the fields marked with * as they are mandatory for reporting the incident.

Name

Contact No *

Low

Medium

High

Very High

Risk *

Incident Description *

Safety Issue Type*

Safety Issue *

Complete Address of Location *

Section Office

Area/Village Name (Gram panchayat/URBAN)*

Date of Reporting/Incident*

Time of Reporting/Incident*

Upload an evidence (if any)