Information

  • Document No.

  • Conducted on

  • Prepared by

Personnel Details :

  • Name:

  • Staff ID :

  • NRIC :

  • Address :

  • Tel. No :

  • Department :

  • Section

  • Shift :

  • Designation

  • Date of Employment :

  • Diseases/Injury :

  • Fist Treatment :

  • Second Treatment :

  • Admitted Date :

  • Discharge Date :

  • MC form :

  • MC Until :

Accident Detail :

  • Date of Accident :

  • Time of Accident :

  • Place of Accident :

  • Describe briefly how it happened :

  • Describe briefly the injuries sustained :

  • Name of person who witnessed the accident (in any) :

  • Name of Claimants :

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.