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Accident Report Form (#62)
I am reporting a :
Loss of time/injury
Work vehicle accident
Work accident
First aid incident
Observation
Person Reporting Incident
First Name
Last Name
Person Involved in Incident
First Name
Last Name
Incident Date and Time
Location of Incident
Please describe the event in detail.
Was damage done to the property?
Yes
No
How many hours were lost because of this incident?
What first aid measures were needed?
Could this incident been avioded?
Yes
No
I certify that the information I have provided is truthful to the best of my knowledge.
Submit Form
Sana Ullah
sana.ullah
Tags
Government
