Audit

General Information
Capture photo of Identification
Date and time of the incident
Location of the incident

Are there other people involved?

Person/s involved? Click "Add"

Person
Capture photo of Identification

Phone Number

Accident Report

What are the details of the accident?

Capture photo evidence
Why did the incident happen?

Please specify

Incurred injuries

Did the employee leave work?

What are the consequences of the accident?

Please specify

Witness/es

Are there any witness/es?

Witness/es? Click "Add"

Witness

Full Name

Phone Number

Statement

Completion

Recommendations to avoid accident recurrence

Supervisor Full Name and Signature