Personal Injury Accident Report Form (Maritime)
1. General Information
Date of Accident
Time of Accident
Location (Vessel/Port/Area)
2. Injured Person Details
Name
Date of Birth
Rank/Position
Employee/Seafarer ID
Nationality
3. Accident Details
Description of Accident
Cause of Accident
Witnesses
4. Injury Details
Type of Injury
Part(s) of Body Injured
Medical Treatment Provided
5. Reporting & Investigation
Reported To
Date Reported
Immediate Action Taken
Preventive Measures Suggested