Painter's District Council 30 - Finishing Contractors Information and Reporting Solutions

FORMS - ACCIDENT REPORT FORM

Due upon a jobsite accident involving a Bargaining Unit Employee.

Employer Name:		Employer Number:
Contact Name:		Contact Number:
Jobsite Name:		Jobsite Address:
Jobsite Supervisor:
Submitted By:		Email:
Date & Time:

Employee Name	Time Of Accident	Date	Witness	Received Medical Care?
				Yes	No
Description

This form must be submitted to the Union within 24 hours of any accident

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