Trenching and Excavation Accident Report Form
General Information
Date of Accident
Time of Accident
Location of Accident
Persons Involved
Name(s)
Job Title/Role
Employer
Incident Description
Describe what happened
List any injuries or damage
Accident Details
Work being performed at the time
Equipment involved
Estimated depth of trench/excavation (ft)
Protective systems in use
Witnesses
Witness Name(s) and Contact Info
Action Taken
Immediate actions taken after accident
Reported to (Name/Title)
Inspector/Reporter Information
Name
Signature
Date