Free Office Accident Report Form Template

Office Accident Report Form

Please fill out this form to report an accident.

Incident Details

Date of Incident

    Location of Incident

      Type of Incident

        • Slip/Fall

        • Equipment Malfunction

        • Physical Injury

        Description of Incident

          Injured Party Details

          Name of Injured Party

            Position/Department

              Phone number

                Injury/Property Damage Details

                Nature of Injury

                  • Minor

                  • Moderate

                  • Severe

                  Was Emergency Services Contacted?

                  Was First Aid Administered?

                  Name:

                  Date:

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