Accident report

Accident report no.:      

Project no.& title A20079-0200S – A New Administration Building and a New Non-Sterile Plant & Warehouse

Contractor ORASCOM Construction (OCA

This report is to be submitted to the Engineer as soon as possible and not later than 24 hrs after an accident

Type of accident (Check all applicable squares):

Auto       Equipment       Bodily injury       Other      

Contractor       Customer       Auto       Other      

Description of accident (Describe in detail; indicate date & time of accident, prevailing conditions, use additional sheet(s) for
witness statements, photographs and sketches or additional information to be followed by police report, if required)

Property damages (Describe property and / or model, make, etc.; if vehicle, state year of make, etc.)

Description of damages and estimated loss:

Owner      

Address      

Injured persons:
1. Name:       Nature of injury:      

Address:       Tel:      

2. Name:       Nature of injury:      

Address:       Tel:      

Witness:
1. Name       Address       Tel      

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Accident report

Corrective action taken:

Submitted by:       Date:      

Position:       Contractor’s authorised signature:      

Resident Engineer’s comments:

Signed (Resident Engineer)      

For Resident Engineer’s use

Close out Submittal
Rev. No. Status
number
Accident report                  
Investigation report                  
Follow up audit                  

Signed (Resident Engineer)       Print name       Date      

cc:      

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