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Injury Report

MOUNTAINVIEW ACCIDENT/INJURY REPORT FORM
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     MOUNTAINVIEW ACCIDENT/INJURY REPORT FORM

     

    A Staff Member closest to the scene of the accident/place of injury fills out this form within 12 hours of the accident. Please give to your respective principal. Thank you.

     

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  • Description of Accident:

    How did the accident happen? What action was the person doing? List anything that the person was doing that would have been considered unsafe when the accident occurred. List any tool, machine or equipment that was involved.

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  • Action Taken After the Accident:

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    Circle the area that was injured on the person. 

    Download this picture then upload it to the next step.

    (*How to download: right click on the image, then save image as...).

     

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    (allowed file types: doc, docx, jpeg, jpg, pdf, png, ppsx, ppt, pptx, txt, zip)
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