| District | Accident Location | Supervisor Name | Employee Name | Date the Employee Notified You | Time the Employee Notified You | Were there any witnesses to the accident? If yes, names and numbers please. | What actions have been taken to prevent future occurrences? | View Entry |
|---|---|---|---|---|---|---|---|---|
| District | Accident Location | Supervisor Name | Employee Name | Date the Employee Notified You | Time the Employee Notified You | Were there any witnesses to the accident? If yes, names and numbers please. | What actions have been taken to prevent future occurrences? | View Entry |
