Workplace Accident Report Slip
Location of Accident | [Location] |
Date & Time of Accident | [Month Day, Year, Time] |
Employee Details
Name | [Your Name] |
Position | [Your Title] |
Department | [Logistics] |
Details of the Incident
[Operating a forklift when it accidentally tipped over while lifting a heavy load.] |
1. Equipment/Machinery involved (if any):
[Tools]
2. Were standard operating procedures being followed?
Witnesses
1 | Name | [Your Name] |
Position | [Your Title] |
Department | [Logistics] |
2 | Name | |
Position | |
Department | |
Injuries Sustained
1. Describe the nature of the injuries:
2. First Aid administered?
3. Was medical attention sought?
4. If yes, name of the medical facility:
Immediate Actions Taken:
Detail any immediate measures taken following the accident (e.g., area cordoned off, machinery shut down)
Reporter Details:
Name | [Your Name] |
Position | [Your Title] |
Department | [Logistics] |
Health & Safety Templates @ Template.net
