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TEMPLATE: Accident Investigation Report

$3.00

This four-page resource contains all the paperwork required to fill when anyone is injured in your workplace. Use this template to quickly and effectively track the details of the accident to satisfy safety laws provincially and federally as well as ensure necessary prevention steps are noted and carried out in a timely and effective manner.

Checklist Includes:

  • Victim/Injured Person Information
    • Name
    • Supervisor
    • Regular Function
    • Function at Time of Accident
    • Shift Time
  • Accident Information
    • Date
    • Location
    • First Aid
    • Other
  • Description of Injury Sustained
    • Nature of Injury
    • Location of Injury
    • Contact Type
    • Causal Agent(s)
  • Witnesses
    • Eyewitnesses
    • Relevant Authority
  • Investigated Facts
    • People Involved
    • Task at Hand
    • Moment of Accident
    • Environment
    • Material/Equipment
    • Organization
  • Investigation Summary
    • Description of events surrounding the incident
  • Analysis
    • Causes
    • Safety Recommendations

*From Module 8 of HR Toolkit, purchase full Module here.

This four-page resource contains all the paperwork required to fill when anyone is injured in your workplace. Use this template to quickly and effectively track the details of the accident to satisfy safety laws provincially and federally as well as ensure necessary prevention steps are noted and carried out in a timely and effective manner.

Checklist Includes:

  • Victim/Injured Person Information
    • Name
    • Supervisor
    • Regular Function
    • Function at Time of Accident
    • Shift Time
  • Accident Information
    • Date
    • Location
    • First Aid
    • Other
  • Description of Injury Sustained
    • Nature of Injury
    • Location of Injury
    • Contact Type
    • Causal Agent(s)
  • Witnesses
    • Eyewitnesses
    • Relevant Authority
  • Investigated Facts
    • People Involved
    • Task at Hand
    • Moment of Accident
    • Environment
    • Material/Equipment
    • Organization
  • Investigation Summary
    • Description of events surrounding the incident
  • Analysis
    • Causes
    • Safety Recommendations

*From Module 8 of HR Toolkit, purchase full Module here.

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