Accident Report

    Kids Incident Form

    Full Name

    Address

    Postcode

    Age if under 16

    Occupation

    Activity being undertaken at time of accident

    About the Person Reporting the Accident (If Not the Same as Above)NOSame as Above

    Full Name

    Address

    Postcode

    Age if under 16

    Occupation

    Activity being undertaken at time of accident

    Date

    About the Accident- When and Where

    Date it took place

    Time

    Where it took place- room or location

    About the Accident – What Happened

    How did the accident happen? What was the cause?

    If there were any injuries, what were they?

    Signature of the employer or person in charge:

    Date:

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