Get Accident Investigation Form

Filling out the Accident Investigation Form online is a crucial step in documenting and analyzing workplace incidents. This guide provides a clear, step-by-step approach to ensure that you can complete the form accurately and effectively.

Follow the steps to fill out the Accident Investigation Form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with the date of the accident, entering the correct date in the format indicated.
3. In Part A of the form, fill out the employee's name, department, title, and details regarding their age and sex.
4. Provide the social security number, location of the accident, and ensure if the accident occurred on state property.
5. Input the date and time of injury, including when the disability began and when the accident was reported.
6. Indicate the weather conditions at the time of the accident and the name of the treating physician.
7. Describe the events that led to the injury, including the employee's actions and the cause of the incident.
8. List the tools or materials the employee was using during the accident and detail the nature of the injury or illness.
9. Document the protective equipment issued to the employee and whether it was used at the time of the accident.
10. Answer if the employee has had a similar injury or illness before, providing the relevant dates.
11. Identify the cause of the accident, selecting from the options provided and explaining the situation.
12. Provide suggestions on how the accident could have been prevented, detailing actionable measures.
13. The immediate supervisor should print their name, sign the report, and provide their contact information.
14. Ensure the supervisor submits the completed report to the program manager within the designated time frame.
15. After completing the form, save the changes, and use options to download, print, or share the document as needed.

Complete and submit your Accident Investigation Form online today to ensure thorough documentation of workplace safety incidents.