Get the free elevator/escalator accident report - State of Tennessee - tn
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LB-0961 (Rev d October 2012) STATE OF TENNESSEE ELEVATOR/ESCALATOR ACCIDENT REPORT STATE/TENN NO Name of Owner/User Owner/User Tel #
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How to fill out elevatorescalator accident report
How to fill out an elevator/escalator accident report:
01
Gather all necessary information: Collect details such as the date, time, and location of the accident. Note down the names and contact information of any witnesses present. Record the name and contact information of the injured party, as well as any other individuals involved in the accident.
02
Describe the accident: Provide a clear and concise description of what happened. Include information about the type of elevator or escalator involved, any malfunctions or warning signs observed, and any actions taken before or after the accident occurred.
03
Document injuries and damages: Note the extent of the injuries sustained by the affected party. Describe any property damages occurred during the accident.
04
Include medical treatment information: If medical treatment was sought, mention the name of the treating facility or healthcare professional. Provide details about any diagnoses, treatments, or medications administered.
05
Provide personal details: Include personal information about the injured party, such as their full name, contact information, and any relevant identification numbers (e.g., employee ID).
06
Attach supporting documents: If there were any photographs, videos, or documents related to the accident, attach them to the report. These may include evidence of faulty equipment, maintenance records, or safety violation reports.
07
Review and submit the report: Before submitting the report, ensure that all information is accurate and complete. Double-check for any errors or omissions. Sign and date the report, and submit it to the appropriate department or authority.
Who needs an elevator/escalator accident report?
An elevator/escalator accident report is usually required by:
01
Property owners and managers: They need the report to investigate the accident, assess liability, and take appropriate measures to prevent future incidents.
02
Insurance companies: The report helps insurance companies evaluate claims and determine the extent of coverage required for medical treatments or property damages.
03
Regulatory agencies: Government agencies that oversee elevator/escalator safety may require accident reports to monitor and identify any patterns or recurring issues. This information can guide their regulatory efforts and ensure compliance with safety standards.
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What is elevatorescalator accident report?
The elevatorescalator accident report is a document that is used to report any accidents or incidents involving elevators or escalators.
Who is required to file elevatorescalator accident report?
Building owners, property managers, or elevator/escalator maintenance companies are typically required to file elevatorescalator accident reports.
How to fill out elevatorescalator accident report?
The elevatorescalator accident report is usually filled out with details of the accident, including location, date, time, description of what occurred, and any injuries or damages.
What is the purpose of elevatorescalator accident report?
The purpose of the elevatorescalator accident report is to document and investigate accidents involving elevators or escalators in order to improve safety and prevent future incidents.
What information must be reported on elevatorescalator accident report?
The elevatorescalator accident report typically requires information such as the location of the incident, date and time, description of what happened, any injuries or damages, and contact information of those involved.
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