TOOLBOXTOPICS.COM
ACCIDENT/INCIDENT INVESTIGATION
REPORT
Personal Injury____________________________ Property Damage__________________________
Name:_________________________________Employee#: _________________________________
Hire Date:_______________________Performing Regular Job:__________________________________________
Type of Injury:__________________________________Nature of Injury:___________________________________
Part of Body Injured:________________________________Nature of Damage:______________________________
Description of Accident: (What occurred? Include photos and diagram.)
Cause of Accident: (How and why did it occur. Documentation to support training.)
Witnesses: (Anyone who may have seen the accident occurred. Name, company, phone#)
Corrective Actions: (Actions taken to prevent recurrence.)
| Project Name: |
Project Location: |
| Investigated By: |
Date: |
Supervisor |
| Equipment involved |
|
Project Name______________________
Investigated by______________________
Equipment involved_________________
Project Location____________________
Supervisor________________________
Date_____________________________
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