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Accident Reporting and investigation form

This procedure guides staff through reporting and investigating a workplace accident or incident.
Grumble Hill
03/05/2025

Accident Reporting and investigation form

This procedure documents workplace accidents and incidents, recording the date, time, code called (e.g., Code Grey, Code White, Rapid Response, Code Blue, or Code Red), and incident type such as trip, fall, slip, or medical event. It also captures the names and contact information of those involved, witnesses on site, the incident location and description, and whether EMS was called.

    Date & Time

    Section #7

    Code Called

    Section #6

    Incident type

    Section #3

    Name persons on site (Doctor ,Nurse, Worker)

    Section #4

    Name of person involved in incident & contact info

    Section #5

    Incident location and discription

    Section #6

    Was EMS called

Source: Grumble Hill (Community Member)

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