Restaurant Employee Accident Incident Report
Employee Information
Employee Name
Employee ID
Job Title
Supervisor Name
Date of Hire
Incident Details
Date of Incident
Time of Incident
Location
Describe the Incident
Possible Cause(s) of the Incident
Describe any Injuries Sustained
Action Taken
First Aid / Treatment Administered
Reported To
Witnesses (Name and Contact)
Preventive Actions Suggested
Signatures
Employee Signature
Date
Supervisor Signature
Date