HR - Investigating Manager's Accident Form

HR – Investigating Manager’s Accident Form

HR: Investigating Manager’s Accident Form

Investigating Manager’s Name

Full first and last name

Date of Report

Location where the injury occurred

Is there property damage

Yes

Does the scene/vehicle pose additional safety concerns?

Yes

Description of vehicle and/or property damage, if applicable:

Details of the investigation:

Did the investigation determine that the employee violated safety procedures?

Did the investigation determine that the employee violated department and/or township policy?

What are you recommendations or what actions have been taken to avoid similar incidents in the future, if applicable?

Does the scene/vehicle pose additional safety concerns?

Yes

If yes, provide details

Additional comments

File Upload

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Physical Address:
400 West Johnstown Road, Suite 200 Gahanna, OH 43230

Mailing Address:
P.O. Box 307630
Gahanna, OH 43230

Phone: (614) 471-4494

Hours:
8 a.m. to 4:30 p.m.
Monday – Friday

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Mission: To provide for the peace, safety and welfare of the citizens of Mifflin Township.