Supervisor Accident Interview Checklist
Employee Details
Date of Interview
Employee Name
Job Title
Department
Accident Details
Date of Accident
Time of Accident
Location of Accident
Description of Accident
Was anyone else involved?
Injuries Sustained
Witness Information
Witness Names and Contact Information
Cause Investigation
What Happened? (Sequence of Events)
Root Cause Analysis
Corrective Actions
Immediate Actions Taken
Further Preventative Actions/Recommendations
Supervisor Notes
Additional Comments
Supervisor Name
Signature
Date