Information

  • Conducted on

  • Prepared by

  • Location
  • Date / Time of,Accident:

  • Name of HEL employee driving vehicle:

  • Date / Time Reported to Foreman/Supervisor:

  • Date / Time Reported to Management:

  • Accident Location:

  • Local Police called?

  • HEL vehicle involved (unit number)

  • Damage to HEL vehicle?

  • HEL VEHICLE PIC#1

  • HEL VEHICLE PIC#2

  • HEL VEHICLE PIC#3

  • Damage to Other Vehicle?

  • OTHER Pic#1

  • OTHER Pic#2

  • OTHER Pic#3

  • Foreman / Construction Foreman / Supervisor:

  • Any Injuries?

  • Any Blood Exposure? If Yes, whose blood and who was exposed?

  • List Names:

  • Witnesses? If Yes, list their names.

  • LIST Names:

  • DESCRIPTION OF HOW ACCIDENT OCCURRED?

  • Any Other Information?

  • Name of Person Completing this Notice:

CC: jmatthews@hobanequipment.com, jpaynton@hobanequipment.com

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.