Title Page

  • Name of the person reporting the accident

  • Date of Accident

  • Time of accident

  • Where did the accident / incident/ near miss happen?

Details of the accident, incident or near miss

  • Who was present at the time of the accident?

  • How did the accident happen? Give details of the events and the cause?

  • Who was involved in the accident?

  • Occupation of the person involved in the accident

  • Was the person involved in the accident injured? If so what was the injury?

  • Were any of D&S IFCA assets damaged? If so give details

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.