Get the free (Near) Accident Notification Form - Tilburg University - tilburguniversity

September 2014 (Near) Accident Notification Form 1. Notification regarding a: ? (work-related) accident ? Near-accident ? With a danger of personal injury ? With minor physical injury* ? Absenteeism

How to fill out near accident notification form

How to fill out a near accident notification form:

1. Begin by gathering all relevant information about the incident, including the date, time, and location. It's important to have accurate details to provide a clear description of what occurred.
2. Describe the events leading up to the near accident in a concise and precise manner. Include any contributing factors or hazards that were involved.
3. Use specific language to describe the potential consequences that could have resulted from the near accident. This helps to highlight the severity and potential risks associated with the incident.
4. Identify any witnesses who were present during the near accident. Include their contact information or any other relevant details that will assist in finding and interviewing them if necessary.
5. Outline any immediate actions that were taken to prevent the near accident from becoming an actual accident. This could include emergency protocols or safety procedures that were implemented to mitigate the risk.
6. Sign and date the form to indicate that the information provided is accurate and complete. Make sure to retain a copy for your records before submitting it to the appropriate authority or department.

Who needs a near accident notification form:

1. Employers: Near accident notification forms are often required by employers to track and investigate incidents that could have potentially resulted in injuries or accidents in the workplace. This helps to identify areas of improvement for safety protocols and prevent future incidents.
2. Organizations and institutions: Various organizations and institutions, such as schools, hospitals, or government agencies, may also require near accident notification forms to document and analyze incidents that occur within their premises. It enables them to take necessary actions for the well-being of employees or the general public.
3. Regulatory bodies and authorities: Near accident notification forms may need to be submitted to regulatory bodies or authorities in certain industries or jurisdictions. This is typically done to comply with legal requirements and facilitate investigations if needed.

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