Pipe Pros Supervisor's Accident Investigation Report

Get all the facts - WHO, WHAT, WHERE, WHEN, WHY, HOW - Study the Accident Site.

NOTE: All accidents, including first aid cases, shall be investigated and reported on this form and sent to the Corpus office within 24 hours to be reviewed to aid in accident/loss control and accident/incident prevention. All spaces are to be completed to the best of your ability.
  • Select your location

  • NATURE OF ACCIDENT (Check all that apply)

  • PERSONAL INFORMATION

  • ACCIDENT INFORMATION

  • Date Format: MM slash DD slash YYYY
  • :
  • Date Format: MM slash DD slash YYYY
  • :
  • Date Format: MM slash DD slash YYYY
  • :

  • What was the nature of the employee’s injury? (Check all that apply)

  • What part of the employee’s body was injured? (Check all that apply)

  • ACCIDENT ANALYSIS (Describe in detail where applicable)

  • Cause of Accident: (check all that apply)

  • Date Format: MM slash DD slash YYYY
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