Underground Mining Accident Report

General Information

Date of Accident Time of Accident Location (Shaft/Level/Section) Reported By

Persons Involved

Name(s) Position/Occupation

Accident Details

Type of Accident Fall of Ground Equipment Collision Fire Flooding Other Description of Accident Nature of Injuries (if any)

Immediate Actions Taken

Actions Taken

Causes and Recommendations

Probable Cause(s) Recommendations