Instructions: Fill in your name and ID number. These are required.
Click the button next to the appropriate answer, or enter your answer in the text box, depending upon the type of question. When you have finished the report, and not before, click the SUBMIT button at the bottom.
Where did the accident occur?
Was anyone injured?
Yes No
If yes, briefly describe the injury:
Briefly, what was done to alleviate the injury?
Describe the accident: what happened, the people involved, what remedial measures were taken and so on.
What should be done to prevent this kind of accident from occurring again?