Accident Investigation Report
Accident Investigation Report
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Injured Person
First Name
Last Name
Accident
Accident date
Accident time
Details of account
I visited the location at
On
And interviewed the injured person and witnesses on
Report
Comment on whether protective clothing was being worn correctly, condition of the equipment, weather or any other relative factors. Were correct work practices being followed? Did the environment conditions (lighting, etc) contribute to the accident?
State duties normally carried out at this location
Probable cause of accident
Recommendations
Have the associated Risk Assessment(s) been reviewed?
Yes
No
Please provide details
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