Form

Accident report

ikona
Name and surname of reporting person *
Company name *
E-mail address of the reporting person *
Telephone number of the reporting person *
Name of the injured person *
Telephone number of the injured person *
Name and surname of witness to the accident
Telephone number of a witness to the accident
Description of the incident (state at what time the employee started work, what position he was in, what activities he was performing and under what circumstances the accident occurred) *