Audit
Select date
Name
Address
Tel number
Position
Site
Descriptions of Accident
Location of Accident.
Time of Accident
Date of accident
Time reported
Date reported
Describe what took place
Describe injury
annotation!!!
If Accident proved fatal or major the H.S.E. MUST BE INFORMED IMMEDIATELY.
Date HSE INFORMED.
Medical attention given
First aid given by
Ambulance called
Taken to hospital
Admitted
Doctor/clinic called
Released
Hospital/doctor name
Details of immediate medical action
If no medical attention was given explain why.
Witnesses
Name
Address
Name
Address
Name
Address
Select date
Other information
Male
Female
National insurance number
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