Title Page
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Who was injured?
From: Center Safety Officer, Vance Schuening
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To:
- Department Director, Manager, Supervisor, HR Manager, Center Director & Deputy Center Director
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RE: Accident Prevention Plan for:
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SNJCC Case #:
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Sedgewick Claim #:
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Date of Injury
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Log # in book
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Associated Cases Included:
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Location of injury:
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Type of Injury:
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Object causing injury:
Description of incident:
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Analysis:
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Root Cause[s]
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Process, Policy or Procedure Enhancement
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