Workplace Accident Report Slip
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?
-
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] |
