Free Retail Store Accident Report Form Template
Retail Store Accident Report Form
Please complete this form to report any accidents or incidents occurring within the retail store.
Date and Time of Accident
Location (Area)
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Aisle
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Checkout Counter
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Stockroom
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Reporter Name
Job Title
Store Name
Phone number
Name of Injured Employee
Incident Description
Provide a detailed account of the incident. Include events leading up to, during, and following the occurrence.
Type of Incident
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Slip, Trip, or Fall
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Falling Object
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Stockroom Accident
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Equipment Malfunction
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Witness Name 1
Phone number
Witness Name 2
Phone number
Upload Relevant Files
Were there any injuries?
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Yes
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No
Description of Injuries or Damages
Describe the type and severity of injuries. Specify who was injured and their condition.
Was medical attention provided?
Immediate Actions Taken
Describe actions taken to address the incident, such as securing the area, first aid, or repairs.
Was the incident reported to a manager?
-
Yes
-
No
Manager Name
Phone Number
Additional Comments
Include any further information, suggestions, or recommendations to prevent future occurrences.
|
Reporter |
[Your Name] Manager |
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