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):