Construction Accident Questionnaire
Report essential details of a construction site accident. Please provide clear and concise information.
Date and time of the accident
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Location of the accident (site/area)
*
Describe what happened
*
Who was involved? (names and roles, if known)
*
Type of incident
*
Slip, trip, or fall
Struck by object
Equipment-related
Exposure to hazardous substance
Other
Were there any injuries?
*
No injuries
Minor injuries
Serious injuries
Fatality
Describe any property or equipment damage
What immediate actions were taken?
*
Are there witnesses?
*
Yes
No
Unknown
Contact information for follow-up (phone or email)
Submit Report
Should be Empty: