Workplace Accident Report Form
Workplace accident report form this form allows visitors or guests to detail the accident in the workplace.
Workplace accident report form. The workplace accident report form is an integral part of any workplace to keep track of any accidents or near misses that occur at the work place. This form shall be. This helps us to identify and correct hazards before they cause serious injuries.
Employees shall use this form to report all work related injuries illnesses or near miss events which could have caused an injury or illness no matter how minor. Make two vacant lines for the location where the event happened. An accident report or incident report is a form that an employee or manager fills out in the case of an injury illness or near miss at the workplace.
The terms accident and incident are often used interchangeably. Employee s report of injury form instructions. On the top most part of your document sheet make a box for the date and time of the incident.
Lastly leave a huge space for the description and details of the accident. Covered establishments are only required to electronically submit information from the osha form 300a summary of work related. However an accident report places more emphasis on an injury sustained whereas an incident report focuses more on the cause of an event and how an employer can prevent it in the future.
How to create an accident report form. Using this checklist can also document workplace violence and be helpful in compensation insurance claims and court cases. Here are ways in drafting and editing a simple accident report form.
Report any details that may have contributed to the incident i e poor lighting. Indicate the individuals involved and the injuries sustained. If one of your employees has a work related injury or illness you must complete and file this form.
Employer s report of work related injury illness state of new york workers compensation board c 2 c. A workplace incident report form is a tool used by any staff to record incidents that caused injuries within the workplace. In order to ensure accuracy here are steps you can take to write a great accident report.
Male wcb case number if you know it. Use additional paper as necessary and attach to form. The workplace accident report form is one of the most important forms to make sure you write correctly.
Health and safety incident report form the incident reported by department email phone ext date of occurrence time exact location accident incident near miss violence ill health safety what happened. This is a flexible template that can be used to report various types of events including accidents injuries workplace incidents property loss or damage and close calls. Writing a great workplace incident report form tip 1.
Use an online form for data storage. It allows you to record information about all parties involved details of the incident itself any law enforcement interaction witness information and whether medical treatment was administered.