Workplace Accident Report Template

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 Helpful Workplace Accident Report Forms.

In as much detail as possible, describe what caused the incident / accident / injury, what you were doing just before the incident, and what you did after the incident. Fill out this form to report a workplace incident that resulted in injury, illness, or a near miss. If the employee is unable, the supervisor shall complete this form, and then submit it to the human resources office. Fill out this form to report a workplace incident that resulted in injury, illness, or a near miss.

Personal Information Employee Name Social Security No.

Name any objects or substances involved. Statement of witness to accident incident identification information name of employee alleging incident title / role shift department witness statement your name was provided as a witness by the employee listed above. 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. Return completed form to :

This Form Serves To Document Select All That Apply

In order to complete a timely and thorough In this article, we’ve gathered the best incident report templates to provide you with the most comprehensive listing, so you can record and preserve key details of an accident, injury, workplace incident, security breach, or any other type of unforeseen event. Report form instructions this form is to be completed by the supervisor of an employee that has experienced an incident resulting in a serious injury or illness.