Free Accident Report Form for Health and Safety

Please fill out this form completely to document any accidents or incidents affecting health and safety in the workplace.
Date and Time of Accident
Location
Office
Construction Site
Common Area
Name of Injured Employee
Role
Employee
Visitor
Contractor
Contact Number
Type of Incident
Slip
Equipment Failure
Hazardous Substance Exposure
Witness Name 1
Phone number
Witness Name 2
Phone number
Description of Incident
Upload Relevant Files
Were there any injuries?
Yes
No
Description of Injuries or Damages
Body Part(s) Affected (if applicable)
First Aid Given?
Yes
No
Medical Attention Needed?
Yes
No
Immediate Actions Taken
Responsible Staff Member Name
Equipment or Hazard Secured?
Yes
No
Health and Safety Officer Name
Phone Number
Additional Notes or Recommendations
Employee | [Your Name] Supervisor |
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