Accident+Report

Accident Report Form
The following is an example of an Accident Report Form on which details of injuries, diseases and dangerous occurrences are notified. || || (Give Details) || || ||
 * //ACCIDENT REPORT FORM// ||
 * **Details of person injured:** ||
 * **Surname Forenames Age DOB** ||
 * **Department Position Held** ||
 * **Date of Accident Time Was Accident Reported in Accident Record Book?** ||
 * **How did Accident Occur?**
 * **Nature of Injuries**
 * **Was First Aid given? By Whom?** ||
 * **Was Injured Person sent to Doctor, Medical Centre or Hospital?**
 * **If so, accompanied by whom?** ||
 * **Name(s) of Witness(es) of the Accident** ||
 * **Any Previous Accident which may have been due to same cause**
 * **Was Accident caused or contributed to by any defect**
 * in working conditions or premises or the conditions**
 * of the furniture, equipment or tools used?** ||
 * Signature of person reporting the accident** …………………………………………
 * Date** …………………………………….
 * Date** …………………………………….