Accident Analysis

 

  Remarks
Subject:                                      
Accident Date: 
Name of company: 
Name of Employee: 
Work permit no: 
Occupation: 
NRIC No.: 
Age: 
Gender: 
Address: 
Date Joined: 
Contracter’s Tel No: 
Place of Accident: 
Description of Machine: 
Name of Witness: 
Witness Address: 
NRIC No./Work Permit No: 
Nature of Injury: 
Expected Duration of Medical Leave(Days): 
Name of Hospital/Clinic: 
Description of Accident: 
Finding of Accident: 

Recommendation to Prevent Recurrence:

 
Action to be taken by:  
Date of Implementation: 

Prepared by (safety officer or supervisor)

 

Endorsed by (project manager):