Accident Report

Please complete the details below to assist us in investigating the incident and ensuring Johnsons remains a safe and secure workplace for everyone.

Fields marked with an * are required

About the Person who had the accident

Section 1) About the person who had the accident

The person who had the accidents name: *

Department *

Is this person employed by Johnsons or agency? *

Address *

Postcode *

About you

Section 2) About you, the person filling in the record

Your name: *

Address *

Department *

Postcode *

About the accident

Section 3) About the accident

What date did the accident happen? *

Where did the accident happen? *

Details of the injury? *

Time of accident *

Details of any witnesses

How did the accident happen? *

Details of the first aid treatment given and by whom: *

Was the person sent to: *

Signature *

Date *

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