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Occupational Safety and Health - Form 3

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Form 3/

Report an Accident Here

Business Details

Business

Address *

Victim DetailsEnter information about the victim

First Name *

Last Name *

Birth Date *

Village *

Contact Number *

Occupation *

Accident DetailsEnter information about the accident that occur

Address *

Date *

Time *

Hours

Minutes

Description *

OthersOther information related to the accident

Severity *

Injury Nature *

Date Reported *

Add document (s) to support report

No file chosen

Support file types are word document and pdf

Add signature *

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