Workplace Accident Investigation Report
General Information
Date of Report
Investigator Name
Department
Accident Details
Date of Accident
Time of Accident
Location
People Involved
Description of Accident
Describe what happened
Immediate Action Taken
Actions Taken After Accident
Investigation Findings
Cause(s) of Accident
Witnesses (if any)
Corrective Actions / Recommendations
Future Preventive Measures
Investigator Signature
Name & Signature
Date