Nurses Involved in Accident

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Date & Time of

No Hospital Ward/Disciplin Name of Nurse


Accident

1 QEH 2 PCW JANUARI - JUN 2017 NIL

DISEDIAKAN OLEH: DISEMAK OLEH


PLEASE RECORD DATA ON NURSES INVOLVED IN ACCIDENTS
Accident happened after Night Duty
Type of Shift Duty
(tick (/) after which Night Duty)

Gred Divided Sleeping


AM PM N Night 1 Night 2 Night 3
Duty Day

NIL - NIL -
VED IN ACCIDENTS FROM 2017
Pls tick (/) if
Type of Accident
Driver/Passenger

Location of Accident Car Vs Car Vs


Car Vs
Lorry/Bu Motorbik Driver Passenger
Car
s e

- - - - - -
Injury sustained Other Remarks
(please decribe injury and
whether required
hospitalization)

NIL TIADA

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