Accident Investigation Form. Complete this form as soon as possible after an incident that results in serious injury or illness. Web updated august 04, 2022.
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An accident incident report is a form that asks for details about an accident that occurs in a vehicle, school, or workplace in order to properly document what took place. This guidance document provides employers with a systems approach to identifying and controlling the underlying or root causes of all incidents in order to prevent their recurrence. Use this vehicle accident investigation report template to document information about the employee and vehicle involved in the accident. Web included on this page, you will find an employee incident/accident report form, a supervisor's incident investigation report template, a statement of witness to accident template, an employee's return to work plan, and many more. Injured employee (complete this part for each injured employee) name of employeedate of birth departmentoriginal hire date job title shift start time months in current job other body part injurednature of injuryarmaccident typeelbowaccident agentwristdescription of injury handfinger toes malefemale Complete and submit this form to the designated safety office within 3 working days of the accident/incident. Please remember to sign and date the form. Details include the location and time of the accident and information about the individuals involved. • identify documents that need to be collected. Web updated august 04, 2022.
Web • create forms to be used for taking notes and documenting conditions. Use to investigate a minor injury or near miss that could have resulted in a serious injury or illness.) Motor vehicle accident (crash) report; Use this vehicle accident investigation report template to document information about the employee and vehicle involved in the accident. • identify documents that need to be collected. Include details such as the name of the driver, date of birth, address, employee phone number, and driver’s license number, among others. Web • create forms to be used for taking notes and documenting conditions. Web accident investigation form step 1: Injured employee (complete this part for each injured employee) name of employeedate of birth departmentoriginal hire date job title shift start time months in current job other body part injurednature of injuryarmaccident typeelbowaccident agentwristdescription of injury handfinger toes malefemale It shall be completed in a timely manner following an incident, and can also be used to investigate a near miss event that could have resulted in an accident or injury. This guidance document provides employers with a systems approach to identifying and controlling the underlying or root causes of all incidents in order to prevent their recurrence.
