Free Accident Report Form for Contractors

Accident Report Form for Contractors
Please fill out this form to report any accidents or incidents on-site.
Date and Time of Accident
Site Address
Contractor Name
Company Name
Name of Injured Employee
Department/Team
Supervisor Name
Contact Number
Type of Incident
Machinery Malfunction
Fall
Exposure to Hazardous Material
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
Did you report this to a supervisor?
Yes
No
Immediate Actions Taken
Employee | [Your Name] Supervisor |
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