Employee Accident Report
Employee Information
Name
Position
Employee ID
Accident Details
Date of Accident
Time of Accident
Location
Activity at Time of Accident
Description of Accident
Injury Information
Type of Injury
Part(s) of Body Injured
Severity of Injury
Minor
Moderate
Severe
First Aid Provided
Witness Information
Witness Name(s)
Witness Contact
Report Completed By
Name
Signature
Date