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FORM 421-1 Adopted Last Revised Review Date June 10, 2010, October 2012 October 2013 Annual Review EMPLOYEE ACCIDENT/VIOLENT INCIDENT REPORT CHECK ONE ? ACCIDENT ? VIOLENT INCIDENT INSTRUCTIONS: ?

How to fill out employee accidentviolent incident report

How to fill out an employee accident/violent incident report:

1. Begin by collecting all relevant information about the incident, such as the date, time, and location. Make sure to note any witnesses present at the scene.
2. Describe the incident in detail, including the events leading up to it, the actions taken during the incident, and any injuries sustained. Use clear and concise language to accurately convey what happened.
3. Provide personal details about the individuals involved, including their names, job titles, and contact information. If applicable, include the department or team they are part of.
4. If there were any immediate medical interventions or first aid administered, document these actions. Include the name(s) of the person(s) involved in providing medical assistance.
5. If any equipment or property was damaged as a result of the incident, make sure to note the items affected and their estimated value. Include any relevant details about repairs or replacement needed.
6. Report any actions taken after the incident, such as seeking further medical attention, contacting law enforcement, or involving human resources. Document the steps taken and any outcomes or resolutions.
7. Provide a section for the individuals involved to sign and date the report. This signature acknowledges the accuracy of the information provided and their agreement with the report's contents.

Who needs an employee accident/violent incident report?

1. Employers: Employers need these reports to maintain a record of workplace incidents and to track patterns in accidents or violent situations. It helps them identify potential safety risks and make necessary changes to prevent future incidents.
2. Employees: Employees involved in an accident or violent incident should complete these reports to ensure all relevant details are documented accurately. This report serves as a formal record of the incident and can be used for insurance or legal purposes.
3. Human Resources: HR departments utilize these reports to investigate incidents, provide necessary support for employees, and determine if any disciplinary or corrective actions need to be taken.
4. Insurance companies: In case of injuries or property damage, insurance companies may require an employee accident/violent incident report to process claims and assess liability.
5. Legal authorities: If the incident involved criminal activity, law enforcement or regulatory agencies may request these reports to launch investigations or take appropriate legal actions.

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What is employee accidentviolent incident report?

The employee accidentviolent incident report is a document that is used to report any workplace accidents or violent incidents involving employees.

Who is required to file employee accidentviolent incident report?

Employers are required to file the employee accidentviolent incident report.

How to fill out employee accidentviolent incident report?

To fill out the employee accidentviolent incident report, you need to provide details such as the date and time of the incident, location, description of the incident, individuals involved, and any witnesses.

What is the purpose of employee accidentviolent incident report?

The purpose of the employee accidentviolent incident report is to document and investigate workplace accidents or violent incidents, identify potential hazards, and prevent future occurrences.

What information must be reported on employee accidentviolent incident report?

The employee accidentviolent incident report must include information such as the date and time of the incident, location, description of the incident, individuals involved, any witnesses, and details of any injuries sustained.