Accident Injury Report Template With Example
Description
How to fill out Accident - Injury Report?
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FAQ
Injury and Lost Time Incident Report Sample Type of incident (injury, near miss, property damage, or theft) Location (Address) Date/time of incident. Name. Name of supervisor. Description of the incident, including specific job site location, the sequence of events, and the results of the event.
Dear [Supervisor Name]: I am respectfully presenting this letter as written notice that I was involved in a work-related accident on [date of incident] at approximately [time of incident]. [I was injured / I became ill] when [give clear details involving the accident, including what led up to it].
A workplace incident report should generally include the following: The incident date, time, and location. A description of what happened. The names and contact information for any witnesses. The names of those involved, including any injured people. The severity of any injuries or damages.
Gather the Facts Identify the Other Driver. Regardless of who caused the accident, you and the other driver need to exchange names and insurance information. ... Vehicle Information. ... Identify the Witnesses. ... Photograph the Scene. ... Give a Chronological Account of What Happened. ... Include the Witness Statements. ... Conclude the Report.
An incident report should include the following details: The person affected and their contact information. A factual description of the incident, including location, date, and time. A description of the incurred injuries if any. Any involved parties or witnesses and their contact information.