PV Gen Accident Report Form

• Client Name & Site Location

• Name of injured person

• Conducted on

  Date

• Prepared by

Accident Details

• Date and time of the accident

  Date

• Location of the accident

• Describe the accident

• Where there any witnesses?

  Yes

  No

  N/A

• Details of witness/es

Person(s) Involved

• Name(s)

• Job title(s)

• Nature and extent of injuries

Accident Category

• Select the appropriate category for the accident

• Slip, Trip or Fall

• Equipment or Machinery related

• Vehicle or Transportation related

• Struck by Object

• Caught in / between objects

• Electrical Incident

• Other (Specify)

Accident Description

• Provide a detailed description of how the accident occurred

Hospital / Medical Details

• Name of Doctor attended

• Date & Time

  Date

• Name of Hospital attended

• Date & Time

  Date

• If attending hospital, what was the duration of the stay

Immediate Actions Taken

• Describe the immediate actions taken to adress the accident and provide assistance

Contributing Factor

• Were there any contributing factors to the accident?

  Yes

  No

  N/A

• Unsafe Work Practices

• Lack of Training

• Equipment Failure

• Environmental Conditions

• Communication Breakdown

• Other (specify)

Investigation

• Will a further investigation be conducted?

  Yes

  No

  N/A

• Please specify the person(s) responsible for the investigation

• Provide any additional details or instructions for the investigation

Preventive Measures

• What preventive measures can be implemented to avoid similar accidents in the future?

Additional Comments

• Is there any additional information or comments you would like to include?

Report Filter

• Name

• Job Title / Role

• Contact Details