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• 0 <br /> Supervisor's Accident/Incident Investigation Report <br /> Injured Employee: Title: <br /> Date of Accident/Incident: Dept.: <br /> Location: Time on this Job: <br /> Engaged in what work when injured: <br /> Nature of accident/incident: <br /> How did accident/incident occur? <br /> What can be done to prevent recurrence of the accident? <br /> What has been done to prevent recurrence of the accident? <br /> Supervisor's Signature: Dept.: Date: <br /> Reviewer's Signature: Dept.: Date: <br /> NOTE: Form to be submitted to the ERM Director of Internal Health and Safety within 2 <br /> days of the accident/incident. <br />