This report is to be completed when a person (non-employee) is injured on company premises. Person’s name: ____________________________________Date of injury: ____/____/____ Why was person on our property?_______________________________________________ What was he/she doing when injured?___________________________________________ _________________________________________________________________________ Did you witness the accident? Yes No Did the person report the injury immediately after the accident? Yes No Describe what happened:_____________________________________________________ _________________________________________________________________________ _________________________________________________________________________ What was the person’s physical condition and appearance when the injury was reported to you? _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ What first aid or treatment did you administer, if any? _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ Did you advise the person to seek outside treatment or did you call a paramedic? _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ Has there been any follow-up to the accident by company or […]

