Business Accident Report Form
This Accident Report Form is designed to capture detailed information regarding incidents within the company for comprehensive analysis and action planning.
I. Incident Information
Date and Time of Incident | |
Location of Incident | |
Weather Conditions | |
Primary Cause of Incident | |
II. Injured Details
Name of Injured Person | |
Position/Role | |
Department | |
Contact Information | |
Nature of Injury | |
III. Witness Information
Name of Witness | |
Contact Information | |
Statement | |
IV. Damage Details
V. Immediate Action Taken
VI. Follow-Up Actions
VII. Recommendations
VIII. Reporting Authority
Reporting Authority Name Position
Date
For Office Use Only:
Incident Report Number Investigator's Name
Date Assigned
Accident Report Form Templates @ Template.net
