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Attachment C <br /> ACCIDENT/INJURY INVESTIGATION REPORT <br /> TO BE COMPLETED IMMEDIATELY AFTER ACCIDENTANJURY <br /> JOB SUPERVISOR TO COMPLETE THIS SECTION; <br /> Project_ <br /> Da to an d Tim e o f Occur rence — — — — <br /> Project Location <br /> Name of Injured Person <br /> Description of Injury <br /> Witness(s) to Accident <br /> Yo ur Description of Accident/Injury (Be specific - Describe what employee was <br /> doing immediately before the accident/injury; what actual object or substance <br /> caused injury, etc.) <br /> What Corrective Action (if any ) Can Be Taken To Prevent a Similar <br /> Accident/ Injury? <br /> Other Comments <br /> Signature of Supervisor <br />