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FOR DEPARTMENT USE ONLYCOMMONWEALTH OF KENTUCKY DIVISION OF MINE SAFETY INITIAL NOTIFICATION OF ACCIDENTFatalSeriousRescueCompany Name:License #:Mine Name:File #:Mine Location:County:Mine Phone:Principal
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How to fill out initial notification of accident

01
To fill out the initial notification of accident, follow these steps:
02
Start by providing complete information about the accident, such as the date, time, and location.
03
Include details about the parties involved, including their names, contact information, and insurance information if available.
04
Describe the nature of the accident, including the type of vehicles involved and any significant damages or injuries.
05
Explain the sequence of events leading up to the accident, including any contributing factors or actions taken by the parties involved.
06
Provide any additional relevant information or comments that may assist in understanding the circumstances surrounding the accident.
07
Review the completed initial notification form for accuracy and completeness before submitting it to the appropriate authorities or insurance company.

Who needs initial notification of accident?

01
Anyone involved in an accident, whether as a driver, passenger, or pedestrian, needs to fill out the initial notification of accident.
02
Insurance companies, law enforcement agencies, and other relevant authorities also require this information for record-keeping and investigation purposes.
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The initial notification of accident is a formal report that must be submitted when an accident occurs at a workplace, detailing the incident and its circumstances.
Typically, the employer or the designated representative is required to file the initial notification of accident.
To fill out the initial notification of accident, you should provide the necessary details regarding the accident, including date, time, location, involved individuals, a description of what happened, and any witnesses.
The purpose of the initial notification of accident is to inform authorities about the occurrence of an accident, initiate investigations if necessary, and ensure proper documentation for future reference.
The initial notification of accident must report the date and time of the accident, location, names of those involved, a brief description of the incident, and witness information.
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