Free Machine Accident Report Form Template
Machine Accident Report Form
Please fill out this form completely to report details of the machine accident.
Personal Information
Name
Position/Job Title
Department
Phone number
Incident Details
Date and Time of Incident
Location of Incident
Description of the Machine Involved
Detailed Description of the Accident
Witness Information (if applicable)
Name
Phone number
Witness Statement
Injury or Damage Details
Were there any injuries?
If yes, describe the injury
Was there any damage to the machine?
If yes, describe the damage
Actions Taken
Describe any immediate actions taken following the incident
Signature
I confirm that the information provided above is accurate to the best of my knowledge.
Name:
Date:
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