Incident/Accident and Investigation Report

Fill below:
  • INJURED PERSON'S DETAILS

  • DETAILS OF THE ACCIDENT

  • :
  • DETAILS OF THE TREATMENT

  • ABOUT THE INJURY [ TICK APPROPRIATE BOX]

  • THE INCIDENT

  • If yes, list names below

  • INCIDENT ANALYSIS

    What contributed to the incident: [describe the factors that contributed to the incident]
  • PREVENTION

  • INVESTIGATION OF INCIDENT

    Incident investigated by:

  • Manager: