Employee Accident Report

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If something occurs to you or your colleagues at the workplace which leads to health problems or various injuries, such incidents should be investigated by the company’s human resources departments and, in some cases, by the court. First, however, the injured should be properly treated.

To help others discover what has actually happened, injured employees or their coworkers and supervisors must use the Employee Accident Report form. This document contains only three pages but assists a lot during the incident investigation.

It is important to mention that this template can be used not only to describe the incident with severe injuries (like amputation, or concussion, or burn) but also to investigate a minor injury that has led to unpleasant consequences and health problems in the future.

What Info Is Available in the Report

Each such report contains the most important information about the injured employee, the incident’s circumstances, the injury, and the things that may help to prevent similar incidents and events in the future.

The report is divided into several blocks, and each block is essential for the investigation, so it is vital to complete the whole template.

Who Should Fill Out the Form

Depending on the injured employee’s condition, there are several options regarding the report’s creators and signatories. The report might be made by the employee themselves if they are in sound mind and can write and fill out forms.

However, if there are issues with the employee that have made them unconscious or unable to write or explain things, the employee’s supervisor or team member may fill out the form.

Below, you will find a detailed guide explaining how to fill out the form correctly. Remember that the document will be used in the investigation and serve as proof. Do not tell lies in the report and be honest. If there is something you do not know or you are not sure of, you had better leave some fields blank.

How to Fill Out the Report Template

Step 1. Download the Proper Template

Before you begin, you have to obtain the correct report template. It can be done easily with our form-building software that lets you download various forms in seconds. Our site can offer the correct Employee Accident Report form among many other legal templates.

Step 2. Read the Instructions at the Beginning

Right before the headline, you will see instructions regarding when the form should be filled out. In particular, they inform that the document must be prepared as soon as possible after the accident. Read the guidelines carefully and proceed to the form itself.
Step 2 to filling out an employee accident report form - instructions

Step 3. Specify the Reason for this Report

Then, you will see a small chart, and in the first part, you will need to specify the reason for writing and submitting this report. You will have six options to choose from (death, first aid only, and others). Select the relevant option and move to the following step.
Step 3 to filling out an employee accident report sample - reason

Step 4. Indicate the Date of the Incident

You have to insert the date when the incident occurred in the following line.
Step 4 to filling out an employee accident report form - date

Step 5. Mark Who Is the Report’s Creator

Next to the date, you will see four options that say who is creating this report. Such templates can be signed by:

  • The employee themselves
  • The employee’s supervisor
  • The employee’s team member(s).

If none of these is relevant, you have the “other” line at the bottom in which you may specify who is reporting.
Step 5 to filling out an employee accident report example - creator

Step 6. Add Info about the Employee and Their Injury

The template’s following block requires you to provide information about the injured employee and their injury (or injuries). If there are several employees who suffered from the incident, you shall print a couple of copies and fill this block out for every injured person.

Write the employee’s name, age, department, gender, and job title at the moment of the incident. On the scheme, choose the affected body part. Describe the nature of the injury: select the most relevant options from the list (bruise, burn, concussion, strain, and others).

On the right of the block, choose the employee’s work time description (full time, part-time, and so on) and the number of months that the employee has been spending on the current position and doing this specific job.
Step 6 to filling out an employee accident report form - injury

Step 7. Describe the Incident

In the next part, you shall describe the incident in accordance with the provided questions. Indicate the exact location and time of the incident. Choose what part of the employee’s workday was affected by the incident (leaving work, mealtime, normal working activities, working overtime, or any other).
Step 7.1 to filling out an employee accident report form - description

Add the names of witnesses if there were any. If there are statements written by witnesses, the incident’s photos, or any other drawings (like maps), write the number of each in the designated position.
Step 7.2 to filling out an employee accident report sample - descriptionStep 7.3 to filling out an employee accident report example - description

Answer if the employee used any personal protective equipment at the moment of the incident. Then, provide the full description of the events leading to the incident step by step, including the names of various tools, machines, and other essential objects that participated (if any). If you need additional space, you may attach a sheet or two to the form.
Step 7.4 to filling out an employee accident report template - description

Step 8. Choose the Possible Reasons for the Incident

Then, you will see a chart where you may try to explain why the incident happened. There will be a list of unsafe working conditions and a list of unsafe acts by people that you may choose from.

In the first list, you will see points like “unsafe clothing”, “unsafe ventilation”, “tool or equipment defective”, and others. In the second list, you will find “operating without permission”, “distraction”, “unsafe lifting”, and other points.

If you choose any point from this or that list, you will have to answer why these points could have happened. Then, answer a couple of “yes or no” questions regarding the employee’s workplace.
Step 8 to filling out an employee accident report template - possible reasons

Step 9. Pass the Document to Your Company’s Representative

The next section allows you to give recommendations on how to prevent incidents like these in the future.

You will be able to select from 10 points or suggest your own actions. Among the offered points are “train the employee”, “redesign task steps”, “stop this activity”, “enforce existing policy”, and other steps.

When you have chosen one or several actions, describe in detail how to act and carry out the options that you have marked.
Step 9 to filling out an employee accident report form - prevention

Step 10. Sign the Report

After you have completed the template and answered all of the questions, you shall sign the document and add some details about yourself at the end. Write your name, title, and department. Date the form.

If there is an investigation team created and its members are known, they may write their names below. Normally, such reports must be reviewed by supervisors or human resources department colleagues, so one of them shall fill out the “reviewed by” part by adding their name, title, and the current date.

After the form is complete and reviewed, the employee’s supervisor or the human resources staff transfers it to the investigation team that will make various decisions regarding the employee’s compensation and the working conditions.
Step 10 to filling out an employee accident report example - signature