Armored Car Services Safety: Accident Investigation Report Mobile App

Included Fields

Customize to add, remove, or edit any of the fields below.

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  Report #

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  Company:

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  Address:

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  Name of injured:

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  S.

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  Sex:

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  Age:

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  Date of accident:

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  Time of accident:

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  Day of accident:

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  Employee's job title:

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  Length of experience on job:

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  Address of location where the accident occurred:

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  Nature of injury, Injury type, and Part of the body affected:

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  Describe the accident and how it occurred:

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  Cause of the accident:

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  equipment required?

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  Was it provided?

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  Was it being used?

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  If "no", explain.

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  trained by supervisor or designated trainer?

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  If "no", explain.

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  Interim corrective actions taken to prevent recurrence:

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  Permanent corrective action recommended to prevent recurrence:

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  Date of report:

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  Prepared by:

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  Supervisor (Signature):

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  Date:

• ...and More!