TOOLBOXTOPICS.COM
ACCIDENT/INCIDENT INVESTIGATION

REPORT
Personal Injury____________________________   Property Damage__________________________
Name:_________________________________Employee#: _________________________________
Hire Date:_______________________Performing Regular Job:__________________________________________
Type of Injury:__________________________________Nature of Injury:___________________________________
Part of Body Injured:________________________________Nature of Damage:______________________________












Description of Accident:  (What occurred?  Include photos and diagram.)






Cause of Accident:  (How and why did it occur. Documentation to support training.)






Witnesses:  (Anyone who may have seen the accident occurred. Name, company, phone#)






Corrective Actions:  (Actions taken to prevent recurrence.)
Project Name: Project Location:
Investigated By: Date: Supervisor
Equipment involved  
Project Name______________________
Investigated by______________________
Equipment involved_________________
Project Location____________________
Supervisor________________________
Date_____________________________
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