Employee accident report



Name of the Department :
Location :
Name of the Person Injured :
Age :
Name of person to whom working:
Profession :
Date and Time of Accident :
Name & Address of the Witness :
Nature of Accident : Minor / Medium / Severe or Major

Details of Accident
(Provide details of how the Accident happened)

Nature of Injury :
Action Taken :
Report Prepared By: Counter Signed by admin manager:



Name of the Project :
Location :
Name of the Person Injured :
Nature of Injury :
Reasons : Individual Fault/ Lack of Supervision/ Lack of Knowledge

Measures Suggested :
Corrective Measures taken

Action taken by admin manager:
Signature of admin manager:
Directions & Signature of Technical Head
Date :

Employee accident report

1. In case of any accident resulting in injury, IMMEDIATELY inform the supervisor-in-charge;

2. Note: in case the injury is a result of a needle stick or cut that causes spill or blood or body fluid, it is important to clean the exposure area with clean soap and water, then contact medical help immediately as well as inform the supervisor-in-charge. Report the actions you have taken (cleaning the blood spill) to the medical staff or supervisor for checking any risk of blood-borne diseases. Then contact or inform the authorized person to contact EH&S immediately for inspecting any potential of blood-borne infection.

3. If you have been exposed or have different injury, you should attend yourself to medical staff immediately, too, or report to the supervisor of the nature of your injury.

4. Follow established procedures under supervisor’s instructions.

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