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EMPLOYEES\' STATE INSURANCE CORPORATIONFORM 11
ACCIDENT BOOK
(Regulation 66)SL.
No. Date of
Noticeable of
Nickname and Address of
Injured PersonSexAgeInsurance No. Shift, department
and Occupation
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How to fill out accident book
How to fill out accident book
01
Open the accident book and locate the first available entry
02
Enter the date and time of the accident
03
Provide details of the person involved in the accident, including their name, contact information, and job role
04
Describe the nature of the accident and how it occurred, including any contributing factors
05
Record any injuries sustained and the severity of each injury
06
Note down any immediate actions taken to address the accident or injury
07
If applicable, include the names and contact information of any witnesses to the accident
08
Sign and date the entry to indicate that it has been accurately recorded
09
Inform the relevant authorities or management about the accident if required
10
Keep a copy of the entry for recordkeeping purposes
Who needs accident book?
01
Accident books are generally required in workplaces, schools, public facilities, and any other environments where accidents or injuries may occur
02
Employers or business owners have a legal responsibility to maintain accident books in order to track and report accidents
03
Employees and individuals who experience or witness an accident should also complete the accident book entry as part of the incident reporting process
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What is accident book?
The accident book is a document used to record details of any accidents, injuries, or dangerous incidents that occur in the workplace.
Who is required to file accident book?
Employers are required to keep an accident book and ensure that all accidents are properly recorded.
How to fill out accident book?
Accident book should be filled out with details of the accident, including date, time, location, nature of the injury, and any first aid given.
What is the purpose of accident book?
The purpose of the accident book is to provide a record of accidents and incidents in the workplace, which can be used for analysis and to improve safety.
What information must be reported on accident book?
Information such as date, time, location, nature of the injury, names of those involved, and any action taken should be reported in the accident book.
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