Free Workplace Accident Report Form Template
Workplace Accident Report Form
Please fill out the form with your information below.
Employee Information
Name
Employee ID
Position
Phone number
Accident Details
Date of Accident
Location of Accident
Description of Incident
Were there any witnesses?
Type of Injury
-
Physical Injury
-
Psychological Impact
Was medical attention required?
Contributing Factors
-
Equipment Failure
-
Unsafe Work Conditions
-
Employee Negligence
Date:
Incident Report Templates @ Template.net
