Report of An Injury
Report of An Injury
Report of An Injury
About you and your organisation Notifier Name Organisation Name Address
Job Title Email Phone No About the incident Incident Date Incident Time In which local authority did the incident occur? (Country, Geographical Area and Local Authority) ,, In which department or where on the premises did the incident happen? What type of work was being carried out (generally the main business activity of the site)? Main Industry Main activity Sub activity About the kind of accident Kind of accident Work process involved Main factor involved
1/2
Fax No
9/30/12
Phone No What is the person's occupation or job title? Work Status Details if the affected person is on a training scheme/employed by someone else About the injured persons injuries Severity of the injury Injuries Part of the body
2/2