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Accident Report Template

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Accident Report Template

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
Draw place on body
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
Add signature
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Please note that this checklist template is a hypothetical appuses-hero example and provides only standard information. The template does not aim to replace, among other things, workplace, health and safety advice, medical advice, diagnosis or treatment, or any other applicable law. You should seek your professional advice to determine whether the use of such a checklist is appropriate in your workplace or jurisdiction.