Safety
In baseball, my theory is to strive for consistency, not to worry about the numbers. If you dwell on statistics you get shortsighted, if you aim for consistency, the numbers will be there at the end. - Tom Seaver

2010 Accident Investigation Follow up log

Today’s Date ______________________
Injured party __________________________________________
Claim Filed Yes ______ No ______

Date of interview with Safety Officer ___________________
Safety Officer’s Name and Phone # _____________________________________________________
Witness’s Name and Phone Number ___________________________________________________
Witness’s Name and Phone Number ___________________________________________________
Witness’s Name and Phone Number ___________________________________________________
Witness’s Name and Phone Number ___________________________________________________

What part of the body was injured ________________________________________________
Was first aid given Yes _____ No _____
By who ____________________________________________________________

Description of Incident (to the best of your knowledge)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

Did someone else cause the accident Yes ______ No ______
Did a piece of equipment cause the accident Yes ______ No ______

What has been done to correct future incidents from happening? ________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

Follow up info if any
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

For more safety-related information and a printable copy of this form, check out our forms page.