SUPERVISOR'S ACCIDENT INVESTIGATION REPORT - RACKING | Single Source Systems Inc.

SUPERVISOR’S ACCIDENT INVESTIGATION REPORT – RACKINGadmin2021-12-09T15:47:44+00:00

SUPERVISOR'S ACCIDENT INVESTIGATION REPORT - RACKING

Foreman's Name(Required)

Your Email(Required)

Employee's Name(Required)

Department:

Occupation

Date of Incident

Time of Incident

:

Nature of Injury/Property Damage:

Object/Equipment/Substance Inflicting Injury:

Medical Treatment by:

Location of Treatment:

Description of Incident:

Contributing Factors:

Loss Severity Potential:

Probable Recurrence Rate:

Action Taken to Prevent Recurrence:

Supervisor/Manager: (Print)(Required)

Signature

Date

Investigated by:

Date

Reviewed by:

Date

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