Free Health and Safety Accident Report Form Template

Health and Safety Accident Report Form

Please fill out this form to report any health or safety incidents.

Date

    Reported By

      Phone Number

        Date and Time of Accident

          Location/Area of Incident

            Description of Accident

              No. of Injured Persons

                Injured Person Details

                  Supporting Documents (if available)

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                    Thank you for your prompt report!

                    We appreciate your attention to safety.

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