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Accident Investigation Report Template Start using template. This accident investigation report template is used to determine the root cause of the accident to prevent future accidents. Safety officers and workplace supervisors can use this accident investigation form during accident investigations.
Complete an Injury and Illness Incident Report (OSHA Form 301) or equivalent form for each injury or illness recorded on this form. If youre not sure whether a case is recordable, call your local OSHA office for help. Feel free to use two lines for a single case if you need to.
Provide the basic facts. If not, start the report with a sentence clearly stating the following basic information: The time, date and location of the incident (be specific; write the exact street address, etc.). Your name and ID number. Names of other members of your organization who were present.
Incident Report Sample Walkthrough: A Step-by-Step Guide Step 1: Provide Fundamental Information. Step 2: Take Note of Any Damages and Injuries. Step 3: Identify Affected Individual(s) Step 4: Identify Witnesses and Take Their Statements. Step 5: Take Action. Step 6: Close Your Report.
Provide date and time of the incident and when it was first reported, details of witnesses, and a succinct statement describing the events leading to the incident, the details of the incident, the type of work being undertaken, any hazards involved in the work and any personal protective equipment being used.
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An incident report form is a worksite tool used to document events that could have caused severe injuries to an individual or damage to the company property.
An incident report should include the following details: The person affected and their contact information. A factual description of the incident, including location, date, and time. A description of the incurred injuries if any. Any involved parties or witnesses and their contact information.
Incident Report Template 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.

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