Business Accident Report Form Template
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Business Accident Report Form
Please fill out this form completely to report any accidents or incidents that occurred on business premises.
Employee/Individual Information
Name
Position/Role (if applicable)
Phone number
Accident Details
Date and Time of Incident
Location of Incident
Description of Incident
Were there any injuries?
If yes, please describe the injuries
Witness Information
Were there any witnesses?
If yes, please provide witness details
Name
Phone number
Action Taken
Was medical assistance provided?
If yes, please describe the assistance
Steps taken after the incident
Signature
By signing below, I confirm that the information provided is accurate to the best of my knowledge.
Name:
Date:
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