Professional Documents
Culture Documents
Accident Report
Accident Report
Section-1
Location Of Accident/Incident
Time Date Of Accident Incident
3 -Equipment Involved
Vehicle Registration #
Plant Serial No
Material Description
SECTION B
6 - Immediate Causal Factor 7 - Contributory Causal Factor
A. Not following Procedures A. Physical capability / condition of person
B. Using incorrect or damaged tools / equipment
C. Safety Devices / guards not secure or emoved, or B. Hazards not identified on risk assessment / method statement
PPE not used
D. Inattention, lack of awareness or poor decision C. Lack of knowledge / training
judgement
E. Horseplay / Violence D. Conflicting instructions
F. Guards or PPE did not work correctly
G.Defective tools or equipment E. Poor supervision / leadership
H.Environmental (fire, noise, temperature, F. Poor planning / method statement
chemicals, act of nature)
I. Workplace environment (electrics, lighting, G. Poor storage of materials / equipment
ventilation, restricted space, housekeeping)
H. Poor tools / equipment used
8 - Photographs
SECTION C CLOSURE
11. Details of person filling out this report
Name Designation
Closure Verification
Zintex have taken the necessary steps to ensure that similar incidents do not happen again in the future.We have informed all parties
involved of the results of our investigation and the measures taken to prevent future accidents. This closure verification confirms that
the accident has been properly investigated and all necessary steps have been taken to ensure the safety of all involved.
Name Designation
Dept Date Signature
Zintex Telicommunications Accident Incident Report Doc-xxxxxxx
Zintex Telicommunications Accident Incident Report Doc-xxxxxxx
Doc-xxxxx-xxxx-xxxx
Zintex Telicommunications LIFE SAVING PRINCIPLES
Location Time