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  • Template Workplace Accident Report

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    Hema Priya
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    An employee was injured at work on a specific date and time. The details of the accident report document the employee's name, job title, location of the accident, what the employee was doing when injured, the nature of the injury, any witnesses, the medical treatment received, and the supervisor notified. The report provides essential information about a workplace accident for documentation purposes.

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    An employee was injured at work on a specific date and time. The details of the accident report document the employee's name, job title, location of the accident, what the employee was doing when injured, the nature of the injury, any witnesses, the medical treatment received, and the supervisor notified. The report provides essential information about a workplace accident for documentation purposes.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    1K views1 page

    Template Workplace Accident Report

    Uploaded by

    Hema Priya
    An employee was injured at work on a specific date and time. The details of the accident report document the employee's name, job title, location of the accident, what the employee was doing when injured, the nature of the injury, any witnesses, the medical treatment received, and the supervisor notified. The report provides essential information about a workplace accident for documentation purposes.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    Workplace Accident Report

    Name Job Title

    DETAILS OF ACCIDENT/INJURY Date and hour of Accident. (day/month/year/time)

    Date and hour reported to the Supervisor (if after the fact) (day/month/year/time)

    Where was the person when the accident/injury occurred?

    To whom was it reported? (Name) If it was not reported immediately, provide reason for the delay.

    What happened to cause the accident/injury? If applicable, describe the injury, the part of the body involved and specify left or right side.

    Describe the persons activities at the time of the accident/injury? Include details of equipment or materials used and the size and weight of objects being handled, if relevant to the cause of the accident.

    Is there anyone else who may have witnessed or who may know about the accident/injury? If so, provide details below. Name(s) Address(es) and phone number(s) if available.

    HEALTH CARE What medical attention/first aid treatment was given to the injured person? If appropriate, list name of medical professional/first aid provider.

    _____________________________________ Signature

    _____________________________________ Date of Report

    Workplace Accident Report

    www.theatreontario.org

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