Manufacturing Plant Machinery Accident Report

Basic Details

Date of Accident Time of Accident Location (Area/Department)

Employee Details

Employee Name Employee ID Position

Machinery Details

Machinery Name/ID Type/Model

Accident Description

Describe What Happened Injury/Injuries (If any)

Witnesses

Witness Name(s)

Immediate Actions Taken

Details of Actions

Supervisor/Manager Reported To

Name Time Reported