【简介】感谢网友“雕龙文库”参与投稿，这里小编给大家分享一些，方便大家学习。
QUESTION 4 CONTINUED
NEILSON CARPET FACTORY
ACCIDENT REPORT FORM
THIS FORM MUST VE COMPLETED IN CAPITALS BY THE PERSON REPORTING THE ACCIDENT ON THE DAY OF THE ACCIDENT
FULL NAME OF INJURED PERSON __________________________
TITLE (MR/MRS/MISS/MS) _______________________________
HOME ADDRESS _________________________________________
_________________________________________
__________________________________________
STATUS OF INJURED PERSON __________________________________________
DATE OF ACCIDENT __________________________________________
TIME OF ACCIDENT __________________________________________
LOCATION OF ACCIENT __________________________________________
DETAILS OF INJURY __________________________________________
CAUSE OF ACCIDENT _________________________________________ (HOW DID IT HAPPEN?)
__________________________________________
__________________________________________
TAKEN TO HOSPITAL YES [] BY AMBULANCE [] BY CAR []
(Please tick) NO []
DO YOU CONSIDER THE COMPANY IS AT FAULT? YES/NO(delete which does not apply)
IF YES’ GIVE REASON _________________________________________
__________________________________________
ACCIDENT REPORTED BY __________________________________________
COMPANY STATUS __________________________________________
DATE SIGNATURE
QUESTION 4 CONTINUED
NEILSON CARPET FACTORY
ACCIDENT REPORT FORM
THIS FORM MUST VE COMPLETED IN CAPITALS BY THE PERSON REPORTING THE ACCIDENT ON THE DAY OF THE ACCIDENT
FULL NAME OF INJURED PERSON __________________________
TITLE (MR/MRS/MISS/MS) _______________________________
HOME ADDRESS _________________________________________
_________________________________________
__________________________________________
STATUS OF INJURED PERSON __________________________________________
DATE OF ACCIDENT __________________________________________
TIME OF ACCIDENT __________________________________________
LOCATION OF ACCIENT __________________________________________
DETAILS OF INJURY __________________________________________
CAUSE OF ACCIDENT _________________________________________ (HOW DID IT HAPPEN?)
__________________________________________
__________________________________________
TAKEN TO HOSPITAL YES [] BY AMBULANCE [] BY CAR []
(Please tick) NO []
DO YOU CONSIDER THE COMPANY IS AT FAULT? YES/NO(delete which does not apply)
IF YES’ GIVE REASON _________________________________________
__________________________________________
ACCIDENT REPORTED BY __________________________________________
COMPANY STATUS __________________________________________
DATE SIGNATURE
