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):

1. [Tools]                  

2.                               

3.                               

2.  Were standard operating procedures being followed?

• Yes

• No

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? 

• Yes

• No

3. Was medical attention sought?

• Yes

• No

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]

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