Home-Incident/Accident Report

  • :
  • The Employee’s description of the Incident /Accident is: (Must be hand-written by injured employee - use separate sheet ifnecessary-be specific as to the body part that is injured)
  • 2.VEHICLE accident: Complete this form, Vehicle Accident Report Form and attach a copy of the police report, if available.
  • 3. If OCCUPATIONAL EXPOSURE, complete the following:
  • EMPLOYEE COUNSELING
  • WITNESS(ES) OF THE INCIDENT/ACCIDENT