Supervisor's Report of an Accident

Supervisor''s Report of an Accident - (Forms/Publications)
Document Information
  Get help downloading & printing files.   How to complete a fillable form.
Title   Supervisor''s Report of an Accident (85 KB PDF)

Supervisors use this form to document information from an accident or injury.

Form number F417-048-000
Online only. See document above to download.
Keywords accident, accident report, report of injury or occupational disease
Languages English
Valid dates 10-2005
Contact information

End of main content, page footer follows.

Access Washington official state portal

© Washington State Dept. of Labor & Industries. Use of this site is subject to the laws of the state of Washington.