Slip and Fall Accident Documentation Form
1. Incident Details
Date of Incident
Time of Incident
Location of Incident
Describe How the Incident Happened
2. Injured Person Information
Full Name
Contact Number
Email Address
Address
3. Injury Details
Describe the Injury
Were Medical Services Provided?
Yes
No
If Yes, Name of Provider/Hospital
4. Witness Information
Witness Name(s)
Witness Contact Information
5. Additional Comments