Supervisor’s Report of Injury or Accident Investigation

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Part 1: Employee’s Report Part 2: Supervisor’s Report of Injury or Accident Investigation


Part 2: Supervisor’s Report of Injury or Accident Investigation

(e.g., 8 a.m. - 5 p.m.)
(e.g., 1:35 p.m.)

 
 
 
 

Describe what took place or what caused you to make this investigation.Get all the facts by studying the job and situation involved.

Question by use of WHY - WHAT - WHERE - WHEN - WHO - HOW

 
 
 

Determine which of the 12 items under E, M, or P (below) require additional attention.

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