Accident Investigation Report
General Information
Date of Report
Location of Accident
Date & Time of Accident
Reported By
Department/Area
People Involved
Name(s)
Title/Role
Contact Information
Description of Accident
Describe What Happened
Witness(es)
Accident Details
Type of Accident
Injuries/Damage
Immediate Actions Taken
Cause Analysis
Root Cause(s)
Contributing Factors
Corrective Actions
Measures to Prevent Recurrence
Responsible Person(s)
Target Date for Completion
Report Completed By
Name
Date