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Accident Investigation Report Template

Use this Accident investigation report template to determine the root cause of the accident to prevent future incidents. This template can be used by workplace supervisors to record accurate information. Follow the points below to utilize this template:
    1. Gather the general information of the harmed employee
    2. Identify the details of the event
    3. Explain the consequences of that accident
    4. Gather witness/es statements if appropriate
    5. Suggest precautions to avoid accident reoccurrence
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Accident Investigation Report Template

Audit

General Information

Attach photo of Identification:

Date and time of the accident:

Location:

Are there other people involved?

Accident Report

Write down all the details of the incident:

Photo evidence:

Cause:

Explain the injuries:

Did the worker need to leave work?

What are the consequences of the accident?

Witness/es

Are there any witness/es?

Completion

How can the accident recurrence be avoided?

Full name and signature of the supervisor:

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