Employee Accident Report Form
Employee Accident Report Form
Please complete this form to facilitate accurate documentation.
Accident Details
Date and Time of Accident
Location of Accident
Type of Accident
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Slip/Trip
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Fall
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Equipment Accident
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Fire
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Chemical Exposure
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Accident Description
Please provide details of the accident including contributing factors, and any relevant circumstances.
Witness Information
Name
Job Title
Employee Information
Date of Report
Name
Job Title
Department
Name:
Date:
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Thank you for submitting a report!
If you have any issues or concerns, please contact [Your Company Number].
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