Supervisor Post Accident Report

Supervisor Vehicle Post Accident Report

Employee Name(Required)

First Last

Date of Accident

Time of Accident(Required)

Employee reported Date

Exact location of Incident(Required)

Day of the Week

Medical Attention(Required)

Employee on Overtime(Required)

Witnesses or People in the Area (plus to add additional)

Vehicle (General / Specific Damage)(Required)

Description of Accident (Include Who was involved, what happened (in detail), where the injury took place, when it happened, why it happened.)

Root Cause - The Real Reason for the Accident (Carelessness, unsafe worker, I don't know will not be accepted)(Required)

How to Prevent this from Repeating (Take Pictures, talk to employees, ask the Safety Manager)(Required)

Upload photos of Accident

Max. file size: 256 MB.

Supervisor Printed Name(Required)

First Last

Supervisor Signature(Required)

Date(Required)

Employee Printed Name(Required)

First Last

Employee Signature(Required)

Date(Required)