Professional Documents
Culture Documents
Accident Investigation Report
Accident Investigation Report
Date of investigation
Investigator
Date of injury
Injured worker
Project location
Project Supervisor
M.O.L. notified?
No
Yes
No Yes
Injured workers
address:
Nature of injury reported (injured body
part):
Factors that led up to accident:
Names and addresses of witnesses and their comments (please use back for additional comments):
Investigator Signature
N/A
Yes
To follow up on
President
(Date)