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0000001001 00000 n Yes No Time of Accident AM.

A Report Form is a form where specific pieces of evidence and issues are being stated. This form can be emailed, hand-carried or faxed to HRD as soon as possible. 0000004101 00000 n HRD will then submit a First Report of Injury and coordinate claims processing with the University’s Workers’ Compensation insurance carrier.

If there are many damaged properties, the employee should state each material on a list.

The second tip is to properly use the collected data for conducting an effective analyzation. x�b```b``���������ˀ �@1V �" �֬�� WS%CF�*�d�����E The type of report form to be used for this case is an accident report form which will indicate the details of the occurrence. This form can be emailed, hand-carried or faxed to HRD as soon as possible.

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systems approach. The first tip that the user must remember is to gather all the data about the accident such as the names of the people involved and pieces of evidence.

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The Incident/Accident Investigation Form provides an outline of needed information.

Your suggestions should be practical and mainly based on the accident that you have reported to the company. x�b```�0Vvw``��0pL`8x��a7T8P���� �����A��$�D����hF�c�=�.�5W�100�g 0000002455 00000 n

0000007930 00000 n The findings of the investigation will form the basis of an action plan to prevent the accident or incident from happening again and for improving your overall management of risk. 0000006535 00000 n

What information is required in an incident report form?

0000001163 00000 n startxref Ά/�2����z��7�a��� �7k=]D�K�����J%�]��9e[1�x�_�9}����E�R*��5�;�>0������M��͌�6L��]zS?�vf������f�-�Ipvg:���R��������7�3�.����{����'���6l�^&����hwǒ߃2��('��>{M�9�^ You may also see.This section will state the type and level of injury that the employee obtained in the accident. 0000000776 00000 n 1066 There are a lot of Uses of Report Forms and one of them is for those who witnessed an accident. 0000003260 00000 n {�a�l�-.

This will also have the nature of the damaged property whether it is applicable for reusing or not.This refers to the details of how the employee received a medical treatment after the accident. %%EOF ƭ�ۡjk1�~��Պ�)@V�*w�;��vS�@�,U����n���@�/��0����|�B��)d�Ih�����8kbuHlZc�mnF׹Ko�81���I=I-@6�� �{dNyAq�C�qz��$��}������G M�h�Ql�{��4��6�tRk?� Tr��@4ظQ���V �e5�b�����AH��{��j(��4J��(�$��s����W5�jG���H��s�j 8,OJ>v„Ai3�R��+QOJ��N���D����n/yC���F�*Zc &������Bv��&0�C��s����T���f������K'M�v��-��V S7ДJ�'��dˁ���d{�!r��t! 0000001258 00000 n 0000000973 00000 n 0000004294 00000 n 0000008770 00000 n 598 0 obj<>stream

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0 Incident: Often referred to as a near miss, this is an event that could have resulted in personal harm or property damage. Your findings will also point to areas of 580 19 %%EOF

0000017610 00000 n 0000003452 00000 n injury/illness to HRD by completing this Accident/Incident Investigation Form immediately following the accident/incident. Accidents don’t only occur within streets and roads but also in a company workplace. Managers are responsible for assisting contractors and visitors in complying with company policy regarding accident reporting whilst on company premises. Accident & Incident Investigation 2 Accident Investigation Definitions The Basics Accident: An unexpected incident or exposure that results in an injury or illness to an employee or property damage.

endstream <<38A0D94BE039DB4D9F8D66545E47FF8D>]>> 3 0 obj This will put the case at a fast pace to acquire a resolution as you have given enough details to aid the investigators in the accident.

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staffs.ac.uk. Most report forms will have a checklist of the various injuries such as bruises and burns. h�TP�n�0��t��A�K�x���]�hG@L �$�#w�<5�l ��N���d'7�F��` �%����G�AFr�LdžzU%�wN�x��s����������v���#R���B�ޕ�P#���?�[. 0000004776 00000 n 0000000016 00000 n H��T�n�0��+�HMjwh�) @uzP$�V+�))�h��CR����E����f��{8?_�]�^�����+�l-x�/����eᭊ����Fc183��7C��3����B�(�d����1d �������jl堡� Accident Incident Investigation Report. 0000002704 00000 n stream

Completing an accident investigation form is an easy task as long as the user of the form knows the details of the accident. 0000001936 00000 n

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This is a report of a: …

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0000001627 00000 n startxref Details.

The first tip that the user must remember is to gather all the data about the accident such as the names of the people involved and pieces of evidence.

endstream endobj 597 0 obj<>/Size 580/Type/XRef>>stream 3 Incident Investigation Report Instructions: Complete this form as soon as possible after an incident that results in serious injury or illness.

0 Filing Deadline: (Determined by your company and state workers compensation program policy. <<98223834EF819C489BDC66C9AB1215FA>]>> 0000005756 00000 n x��[I������y�v�E�0`Y� �M�@AN�Irx/������"U�Uvw�ܢ̥X�WE������]߽��8

0000000016 00000 n Employee's Name Length of Employment Job Title �++�N�YZ[B������1�0�m�~�T�� 5�ݗ�� Supervisor's Accident Investigation Form To Be Completed By The Employee's Immediate Supervisor Within 5 Days of Accident And Returned To Gil Calhoun Location where accident occurred Date of Accident Employer's premises? You may also see.

injury/illness to HRD by completing this Accident/Incident Investigation Form immediately following the accident/incident.

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3. The report date of the accident is also included in this section.

Additional tools to assist with the investigation process are found in Appendices B through F. HRD will then submit a First Report of Injury and coordinate claims processing with the University’s Workers’ Compensation insurance carrier. stream Filing Deadline: (Determined by your company and state workers compensation program policy. An effective investigation requires a methodical, structured approach to information gathering, collation and analysis.

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