Environmental Engineering Reference
In-Depth Information
InItIAl InvestIgAtIon InFormAtIon
ACCIDENT.I.D..No.:.. ____________________________________
ACCIDENT.INVESTIGATOR:.._____________________________ .PHONE:..____________________
SPECIAL.INVESTIGATOR:.. ______________________________ .PHONE:..____________________
WITNESSES.TO.ACCIDENT:.._____________________________
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DATE.OF.ACCIDENT:..__________________________ .TIME.OF.ACCIDENT:.._________ .AM/PM
DATE.OF.INVESTIGATION:.._____________________________
MINE.RESCUE.INVOLVED:.
□
.YES.
□
.NO
RESPONSIBLE.PERSON.AT.ACCIDENT.SITE:..___________________________________________
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OFFICIAL.RESPONSIBLE.FOR.EQUIPMENT:.. ___________________________________________
If.Accident.Occurred.Off.Property.or.in.an.Ofice,.Describe.Location.and.Identify.Owner/Operator:
____________________________________________________________________________________
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____________________________________________________________________________________
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