Free Retail Accident Report Form Template

Retail Accident Report Form

Please fill out this form completely to document any accidents or incidents occurring in the retail environment.

Date and Time of Accident

Location

    • Office Area

    • Conference Room

    • Parking Lot]

    Name of Injured Party

      Department/Team

        Role

          • Customer

          • Employee

          • Visitor

          Type of Incident

            • Slip

            • Fall

            • Collision

            Describe the Accident

              Witness Name 1

                Phone number

                  Witness Name 2

                    Phone number

                      Upload Relevant Files

                        Were there any injuries?

                          • Yes

                          • No

                          If yes, please input the details of the injury sustained.

                          Body Part(s) Affected (if applicable)

                          First Aid Given?

                            • Yes

                            • No

                            Medical Attention Needed?

                              • Yes

                              • No

                              Other Impact on Work or Workplace

                              Immediate Actions Taken

                              Staff Responsible for Handling Incident

                              Manager/Supervisor Name

                              Phone Number

                                Additional Notes or Recommendations

                                  Employee

                                  [Your Name]

                                  Manager/Supervisor

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