Free Small Businesses Accident Report Form Template
Small Businesses Accident Report Form
Please complete this form to document the details of any accident or incident that occurs.
Personal Information
Name
Position/Role
Phone number
Accident Details
Date and Time of Accident
Location of Accident
Type of Accident
-
Slip/Fall
-
Equipment Malfunction
-
Collision
-
Description of Incident
Injuries Sustained
Were there any injuries?
If yes, please describe
Witness Information
Were there any witnesses?
If yes, please provide their details:
Name
Phone number
Action Taken
Was first aid provided?
If yes, by whom?
Additional actions or notes
Acknowledgment
By signing below, I confirm that the information provided is accurate to the best of my knowledge.
Name:
Date:
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