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U.S. Department of LaborPreliminary Report of AccidentMine Safety and Health AdministrationPR001 06/14/2023 2. Accident Classification 17 Machinery1. Accident Type F Fatal Injury 6. Mine Information

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How to fill out machine-related injuries in form

01

Write down the date and time of the accident.

02

Describe how the injury occurred and the part(s) of the body affected.

03

Mention any witnesses to the accident, if applicable.

04

Provide details about the machine involved, including its make and model.

05

Note any safety precautions that were in place at the time of the accident.

Who needs machine-related injuries in form?

01

Employees who have experienced machine-related injuries at work.

02

Employers who are required to keep records of workplace accidents.

03

Safety inspectors or regulatory agencies who may investigate the incident.

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What is machine-related injuries in form?

Machine-related injuries in form is a document used to report injuries caused by machines or equipment in the workplace.

Who is required to file machine-related injuries in form?

Employers are required to file machine-related injuries in form.

How to fill out machine-related injuries in form?

Machine-related injuries in form should be filled out with details of the injured person, description of the injury, the machine involved, and any corrective actions taken.

What is the purpose of machine-related injuries in form?

The purpose of machine-related injuries in form is to track and document workplace injuries caused by machines, in order to prevent similar incidents in the future.

What information must be reported on machine-related injuries in form?

Information such as details of the injured person, description of the injury, the machine involved, and any corrective actions taken must be reported on machine-related injuries in form.

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