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SUPERVISOR'S ACCIDENTANCIDENT 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: To be submitted to the Health and Safety Manager within 2 days of the accident/incident. <br />