ACCIDENT / INCIDENT INFORMATION REPORT

PHARMA LIMITED

UNIT

                                    ACCIDENT / INCIDENT INFORMATION REPORT

1. Name of the injured person                         :

2. Designation                                                  :

3. Date, Shift & time of Accident / Incident    : 

4. Name of the Sift In-charge                          :

5. Section or department and exact place where          :

    the accident  took place.                 

6. State PPE used at the time of                                   :

    Accident / Incident.

7. State what injured person was doing at that             :

    time.

8. Describe briefly how the Accident / Incident           :

    occurred.

9. Nature, location and extent of injury                       :

 

Signature of the shift In-charge / Supervisor

Note: This report is to be sent to the time office (Security) within 2 Hrs from the time of Accident / Incident.