Title Page

  • Who was injured?

From: Center Safety Officer, Vance Schuening

  • To:

  • RE: Accident Prevention Plan for:

  • SNJCC Case #:

  • Sedgewick Claim #:

  • Date of Injury

  • Log # in book

  • Associated Cases Included:

  • Location of injury:

  • Type of Injury:

  • Object causing injury:

Description of incident:

  • undefined

Analysis:

  • undefined

Root Cause[s]

  • undefined

Process, Policy or Procedure Enhancement

  • undefined

  • Please be specific.s

Updates

  • Are there any updates to this case?

  • What are the updates?

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