Get Form- Xiv

Filling out FORM- XIV, also known as the report of accident and dangerous occurrences, is an essential step in documenting workplace incidents. This guide will provide you with a clear and supportive walkthrough to ensure that all necessary information is accurately captured in the online form.

Follow the steps to successfully complete your FORM- XIV online.

1. Begin by clicking the ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Enter the name of the project or work at the designated field.
3. Provide the location of the project or work; this should include the specific address.
4. Indicate the stage of construction work by selecting the appropriate option from the list.
5. Fill in the particulars of the employer, including the name and contact details.
6. Enter the main contractor firm or company information, followed by the particulars of any subcontractors including their name, address, phone numbers, and nature of business.
7. Detail the particulars of the injured person, including their first name, middle name, surname, home address, occupation, employment status (casual/permanent), sex, age, marital status, and experience.
8. Provide particulars of the accident including the exact place where the accident occurred, the date, what the injured person was doing at the time of the accident, the weather condition, how long the injured person had been employed for that particular job, particulars of the equipment or machine involved, the time the accident occurred, and a brief description of the accident.
9. Specify the nature of injuries sustained: indicate if they are fatal or non-fatal. If non-fatal, describe the injuries in detail. Additionally, note whether first aid was given, and if not, provide reasons and the details of the person who administered first aid.
10. If admitted to hospital, provide the name, address, and phone number of the hospital; also include the name of the doctor attending to the injured person.
11. Document the mode of transport used to shift the injured person and how long it took, stating reasons if it was delayed.
12. Indicate how the reporting of the accident was made, whether by telephone, telegram, messenger, or letter.
13. Describe who visited the accident site first and any actions proposed.
14. Outline the investigations taken by the employer, including photographs, video film, and measurements.
15. Provide details of witnesses, including names, addresses, and occupations of all witnesses.
16. If the incident resulted in a fatality, fill out the specific date, time, and location and check if registered with the Building and other Construction Workers Welfare Board.
17. Detail any dangerous occurrences as covered under the regulations by providing relevant information.
18. Finally, the employer or authorized signatory must certify the information provided is correct. Include the place, their signature, and designation before forwarding for follow-up action.

Complete your FORM- XIV online today to ensure proper documentation of workplace incidents.