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.
Student Accident Report Form
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State:
Multi-State
Control #:
US-02520BG
Format:
Word;
PDF;
Rich Text
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Sign and collect signatures with our SignNow integration. Send to multiple recipients, set reminders, and more. Go Premium to unlock E-Sign.
If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.
We protect your documents and personal data by following strict security and privacy standards.
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FAQ
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.
RIDDOR puts duties on employers, the self-employed and people in control of work premises (the Responsible Person) to report certain serious workplace accidents, occupational diseases and specified dangerous occurrences (near misses).
In the event of an accident in the workplace that you or a colleague has been involved in, you may need to record the incident. The accident report form covers the workers involved as well as the company should any repercussions occur. It also helps to track trends in occupational injury so they can then be rectified.
Date, time and specific location of incident. Names, job titles and department of employees involved and immediate supervisors. Names and accounts of witnesses. Events leading up to incident. Specifically what the employee was doing at the moment of the accident.
The accident book can be filled out by anyone, but it should be checked by the qualified first aider in your workplace. It's more important that the details written in the accident book are accurate, rather than who fills it out. Ideally, someone with first-hand involvement in the accident would write the record.
Ensure that all essential questions (what, where, when, why, and how) are covered in the incident report. Record not only the people who were injured and what caused the accident to happen, but also include details such as people who witnessed and reported the incident or those who will conduct an investigation.
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.
The time and date the incident occurred. Where the incident occurred. A concise but complete description of the incident. A description of the damages that resulted. The names and contact information of all involved parties and witnesses. Pictures of the area and any property damage.
The accident book can be filled out by anyone, but it should be checked by the qualified first aider in your workplace. It's more important that the details written in the accident book are accurate, rather than who fills it out. Ideally, someone with first-hand involvement in the accident would write the record.
