Manufacturing Plant Machinery Accident Report
Accident Details
Date of Accident
Time of Accident
Location (Area/Section)
Machinery Involved
Machine ID / Number
Description of Event
Injured Person(s) Information
Name
Position/Job Title
Employee ID
Description of Injury
Medical Attention Required
Yes
No
Witnesses
Witness Name(s)
Witness Statement(s)
Immediate Actions Taken
Investigation/Analysis
Root Cause(s)
Corrective Actions Proposed
Report Prepared By
Name
Date