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Accident Report Sample

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Accident Report Sample
How to Write a Good Accident or Incident Report

An incident report needs to include all the essential information about the accident or near-miss. The report-writing process begins with fact finding and ends with recommendations for preventing future accidents.
You may use a special incident reporting form, and it might be quite extensive. But writing any incident report involves four basic steps, and those are the focus of today’s post.
1. Find the Facts
To prepare for writing an accident report, you have to gather and record all the facts. For example:
· Date, time, and specific location of incident
· Names, job titles, and department of employees involved and immediate supervisor(s)
· Names and accounts of witnesses
· Events leading up to incident
· Exactly what employee was doing at the moment of the accident
· Environmental conditions (e.g. slippery floor, inadequate lighting, noise, etc.)
· Circumstances (including tasks, equipment, tools, materials, PPE, etc.)
· Specific injuries (including part(s) of body injured and nature and extent of injuries)
· Type of treatment for injuries
· Damage to equipment, materials, etc.
2. Determine the Sequence
Based on the facts, you should be able to determine the sequence of events. In your report, describe this sequence in detail, including:
· Events leading up to the incident. Was the employee walking, running, bending over, squatting, climbing, lifting operating machinery, pushing a broom, turning a valve, using a tool, handling hazardous materials, etc.?
· Events involved in the incident. Was the employee struck by an object or caught in/on/between objects? Did the worker fall on the same level or from a height? Did the employee inhale hazardous vapors or get splashed with a hazardous chemical?
· Events immediately following the incident. What did the employee do: Grab a knee? Start limping? Hold his/her arm? Complain about back pain? Put a hand over a bleeding wound? Also describe how other

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