This form is a generic example that may be referred to when preparing such a form for your particular state. It is for illustrative purposes only. Local laws should be consulted to determine any specific requirements for such a form in a particular jurisdiction.
California Student Accident Report Form
Category:
State:
Multi-State
Control #:
US-02520BG
Format:
Word;
PDF;
Rich Text
Instant download
Description
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How to fill out Student Accident Report Form?
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FAQ
LIC 624 - Unusual Incident/Injury Report. Page 1. I. STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY. CALIFORNIA DEPARTMENT OF SOCIAL SERVICES.
Every incident report you file should contain a minimum of the following: Type of incident (injury, near miss, property damage, or theft) Address. Date of incident. Time of incident. Name of affected individual. A narrative description of the incident, including the sequence of events and results of the incident.
9 facts related to the incident include: The Basics. Identify the specific location, time and date of the incident. ... The Affected. Collect details of those involved and/or affected by the incident. ... The Witnesses. ... The Context. ... The Actions. ... The Environment. ... The Injuries. ... The Treatment.
Keep in mind that these three considerations are not to be confused with the three requirements for writing an incident report: The report must be factual and without assumption. An incident report must be accurate and without bias. The incident report must be complete.
Basic Incident Information the names and positions of the people involved. the names of any witnesses. the exact location and/or address of the incident. the exact time and date of the occurrence. a detailed and clear description of what exactly happened. a description of the injuries.
Accidents Report Forms and the Workplace Accidents can happen in any work place at any time and Accident Report Forms are there to record every incident. Your employer is under a clear duty to keep you safe and ensure that you are advised about relevant health and safety issues.
Accident report forms should include fields for names and contact information of the individuals and witnesses involved, the type of accident, the date and time the accident occurred, the location of the accident, a detailed description of the accident, and room for any additional comments.
The 4 main incident reports that should be on your list are: Near Miss Reports. Near misses are events where no one was injured, but given a slight change in timing or action, someone could have been. ... Injury and Lost Time Incident Report. ... Exposure Incident Report. ... Sentinel Event Report.