Accident Investigation Report
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ACCIDENT INVESTIGATION REPORT Name of Injured Member: Employer: Component: Work Location: Address: Hours of Work: Classification of Injured Member: Date of Accident/Incident: Injured Member’s Address: Telephone No.: Injured Member’s Supervisor: Accident/Incident Reported To: Date Accident/Incident Reported: Date and Time of Accident/Incident: Site (Physical Location) of Accident/Incident: Weather Conditions (If Applicable): Time of Accident/Incident: Description of Accident/Incident Events: Description of Injury: Direct Cause of Injury: Accident Causes (List all possible causes): Accident Type: Recommendations: Equipment Involved in Accident/Incident: Name of Witness(es): Was First Aid Given Telephone No..
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