Staff Accident Report Please complete and submit this report any time a member of our staff is injured at work. Please enable JavaScript in your browser to complete this form.Report submitted by *FirstLastInjured staff member *FirstLastDate and time accident occured *DateTimeAccident location *What happened? *Describe the injury. *Action taken (check all that apply) *Treated on siteWent to urgent care clinicWent to hospitalWent homeOther (describe below)Describe other action taken *Did the injured staff member leave the premises under their own power? *YesNo (explain below)How did the injured staff member leave the premises? *Recommended steps to take to avoid accidents of this nature in the futureSubmit
