HTML Preview Accident Investigation page number 1.
Accident Investigation Report
S:\Health & Safety\Accident Investigation\AIR – AI-001.doc
Version 1.4 (July 2008) Page 1 of 12
REF: Number
Notification of Accident at work
In the event of an Accident, please complete the following:
Site:
Date of Accident:
Department:
About the person involved in the accident:
Name:
Male:
Female:
Address:
Date of birth:
Home Telephone Number:
Occupation:
Length of Service:
Operation:
Site Name:
Address:
Shift Pattern:
Time of Accident:
(Please use 24 hr
format)
Location of accident: (if off site please include address)
Warehouse
Yard
Delivery Point
Office
Pick up point
Other (Please Specify)
Job Description at time of accident:
FLT driving
Store
delivery/Collection
Unloading
Garment processing
Loading
Pack/repack
Order Picking
Other (Please Specify)
Environmental Conditions:
Dark
Light
Poorly Lit
Direct Sunlight
Dry
Wet
Slippery
Windy
Hot
Warm
Humid
Cold
Even Floor
Uneven
Different levels
Foggy
Noisy
Quiet
Other: