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Be specific* F A. M. P. M. Location Was First Aid Given If yes when By Whom N/A Illness or Injury if applicable Where Child Received Medical Treatment if known Phone Number of Treating Physician Medical Facility Hospital if applicable Any Handicaps Health Problems or Exceptions Listed on the Child s Health Records if applicable If Fire Describe Damage PERSON S NOTIFIED Law enforcement fire marshal parent/legal guardian etc* Name of Person Notified Notification Date Signature of Person Completin ...

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What is an example of an accident at work?

major injuries, a broken arm or ribs for example. dangerous incidents like the collapse of scaffolding, people overcome by gas. any other injury that stops an employee from doing their normal work for more than three days. disease.

What is an example of an incident and an accident?

For instance, a car collision that results in physical harm or property damage is classified as an accident. On the other hand, incidents are characterized by their potential to cause harm or damage. Though an incident may not result in immediate harm or damage, the potential for serious repercussions is inherent.

What is the format of accident report?

Collect the necessary information for the report, such as the names, contact information, and roles of the people involved as well as any witnesses. Record the date, time, and location of the incident. Document the incident. Describe the incident in detail.

How do you write an accident report at work sample?

What to include in a work incident report The date and time of the incident. The name of the witness or author of the report. A detailed description of the events. The names of the affected parties. Other witness statements or important information. The result of the incident.

How do I write an employee accident report?

For example: Date, time, and specific location of incident. Names, job titles, and department of employees involved and immediate supervisor(s) Names and accounts of witnesses. Events leading up to incident. Exactly what employee was doing at the moment of the accident.