Accident Report

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Accident Report

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