Employee Accident Report Form

There are many professions which are considered risky.  Professions in the construction industry, engineering industry require safety measures to be followed.  However when unavoidable accidents happen then an employee accident report form should be filled out. An employee accident report form enables the employee to record details of the accident so appropriate action is taken.

Sample Employee Accident Report Form

Employee accident report form no: _____________________ Date: _____________

Company name: ____________________ Company logo: _______________________

Employee name: ____________________ Occupation: _________________________

Job title: ___________________________ Department: _________________________

Address: ___________________________ State: ______________________________

Location: __________________________ Tel no: _____________________________

Mob no: ___________________________ Fax no: _____________________________

Email address: ______________________

Please state when the accident occurred:

________________________________________________________________________

Please state where the accident occurred:

________________________________________________________________________

Please state which injuries you incurred due to the accident:

________________________________________________________________________

Please state the action the company took to deal with your accident:

________________________________________________________________________

Recommendations:

________________________________________________________________________

Please sign here below to acknowledge the information you have given is truthful and accurate.

Sig: ______________________________ Date: _______________________________

Category: Report Forms