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HTML Preview Accident Investigation page number 1.
1
Accident Invest
igation Report
S:
\
Health & Saf
ety
\
Accident I
nvestigation
\
AIR
–
AI
-
001.doc
Version 1.4 (
July
2008
)
Page
1
of
12
REF: Nu
mber
Notif
icat
ion
of
Acci
dent
at work
In the e
vent o
f an Ac
ciden
t, pleas
e com
plete
the follo
wing:
Site:
Date
of Ac
ciden
t:
Depart
ment:
About
the
perso
n in
volve
d in
the
acc
ident
:
Name:
Male:
Female:
Address:
Date
of b
irt
h:
Home Tel
ephone
Num
ber:
Occupat
ion
:
Length of
Service:
Operat
ion:
Site
Name:
Address:
Shift
Patt
ern:
Time of Acc
ident:
(Please us
e 24 hr
forma
t)
Location of
accident:
(if off site please include address)
Ware
hou
se
Yard
Deliv
ery
Point
Offi
ce
Pick up
point
O
the
r (Pleas
e Spe
cify)
Job Description at
time of
accident:
FLT drivi
ng
Store
delivery
/Collection
Unloadi
ng
Garment
pr
ocess
ing
Loading
Pack/rep
ack
Order
Pic
king
Other
(Pl
ease
Spec
ify
)
Environmental
Condit
ions:
Dark
Light
Poorly
Lit
Di
rect Sunlight
Dry
Wet
Slipper
y
Wind
y
Hot
Warm
Humid
Cold
Even Flo
or
Uneven
Diff
erent
l
evels
Foggy
Noisy
Quiet
Other
:
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The worst part of success is to try to find someone who is happy for you. | Bette Midler