Title Page

  • Accident description

Accident Form

Details about the person who had the accident

  • Is the injured person at the scene and able to give details?

Details about the person filling in the record

  • name

  • Department

About the accident

  • Name of the person who had the accident

  • Contact details of the person that had the accident

  • Date and time of the accident

  • Location

  • How the accident happened along with the possible cause

  • Injury sustained

  • Any other notes

  • If applicable a picture of the cause of the accident (not the injury)

Sign once completed and send a copy to the site Manager and Head Of Facilities

  • Sign once completed

  • Give basic details of accident

  • Date and time of the accident

  • Sign as completed

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.