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SlideshowReport

An example of a typical incident report.

Description
Name of injured party — Date
Address — Telephone
me injured puny was: [1 Employee [1 Patient D mher
Date mucmemnncicent — Time or incident
Where did incideni nccm’?
Names oi witnesses (include tides):
WM! first alfl/Imalmem was given at the time 01 the incident?
Who administered first aid?
Briefly describe the incident.
Names at emplwezs present at time at incident/min :
What. in your opinion, caused the accident? —
Folluw-up: what steps have been Lulu!" to prevent a simillr accident?
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