If you are involved in an accident or incident, determine if everyone is ok and assess the situation. If there are injuries that require immediate medical attention, immediately dial 911 and seek help, you can complete the following steps and seek help from the office once the scene of the accident is secure and no further risk of harm is imminent.

If there is damage to a vehicle, property, equipment, and or injuries to a team member, immediately inform the office and complete an Accident/Incident Report as soon as practical.

Person Completing the Report

Full Name

Phone Number *

Email Address *

Who was injured?

Employee

Client

Other

Injured Person Details

Name of Person Injured

Phone Number

Date of Birth of Injured Person

Date of Incident

Location of Incident

Type of Injury

Description of Accident/ Incident

Were emergency services needed and contacted?

Yes

Did injury require hospital visit?

Yes

Name of Hospital & Physician

Address of Hospital Physician

Were there any other damages? (Vehicles, Property or Equipment)

Yes

Please upload any other additional documentation or photos: