Free Workplace Accident Report Template

Workplace Accident Report

Please fill out this form to document the details of the accident.

Reporting Person

    Role/Position

      Phone Number

        Date and Time of Accident

        Location of Accident

          Description of Accident

            Injured Party

              Type of Injury

                • Sprain

                • Laceration

                • Bruise

                • Fracture

                • Burn

                Was medical attention required?

                Additional Notes

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