All accidents are considered as incidents; however an accident report form focuses more on the injury.
An accident report is an important tool used to document the accident and assist in investigating the cause. It also assists to develop procedures that may be put in place to prevent it from happening again.
Virgin Islands Accident or Injury Report
Category:
State:
Multi-State
Control #:
US-0022BG
Format:
Word;
Rich Text
Instant download
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Public form
Description
How to fill out Accident Or Injury Report?
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FAQ
Ensure that all essential questions (what, where, when, why, and how) are covered in the incident report. Record not only the people who were injured and what caused the accident to happen, but also include details such as people who witnessed and reported the incident or those who will conduct an investigation.
Every incident report you file should contain a minimum of the following: Type of incident (injury, near miss, property damage, or theft) Address. Date of incident. Time of incident. Name of affected individual. A narrative description of the incident, including the sequence of events and results of the incident.
9 facts related to the incident include: The Basics. Identify the specific location, time and date of the incident. ... The Affected. Collect details of those involved and/or affected by the incident. ... The Witnesses. ... The Context. ... The Actions. ... The Environment. ... The Injuries. ... The Treatment.
Dear [Supervisor Name]: I am respectfully presenting this letter as written notice that I was involved in a work-related accident on [date of incident] at approximately [time of incident]. [I was injured / I became ill] when [give clear details involving the accident, including what led up to it].
Injury and Lost Time Incident Report Sample Type of incident (injury, near miss, property damage, or theft) Location (Address) Date/time of incident. Name. Name of supervisor. Description of the incident, including specific job site location, the sequence of events, and the results of the event.
Incident Report Sample Walkthrough: A Step-by-Step Guide Step 1: Provide Fundamental Information. ... Step 2: Take Note of Any Damages and Injuries. ... Step 3: Identify Affected Individual(s) ... Step 4: Identify Witnesses and Take Their Statements. ... Step 5: Take Action. ... Step 6: Close Your Report.
Keep in mind that these three considerations are not to be confused with the three requirements for writing an incident report: The report must be factual and without assumption. An incident report must be accurate and without bias. The incident report must be complete.