Selecting the Investigation Board

Acorn Company First Report of Accident or Near Miss 

Accidents that result in personnel injuries or equipment damage must be reported to the safety office (x2222) immediately. This form must be submitted to safety within 24 h of the reported incident. Attach additional sheets if more space is required. 

Section 1 (To Be Completed by Reporting Employee) Date of Report  

Facilities, Tooling, or Other Equipment Used at Time of Accident  

List of Work Orders or Procedures In Use at Time of Accident  

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