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Current language of the form is English

Entry in the electronic register "Werkstatt Kernweg 4"

Details of the course of the accident or damage to health

Name of the injured or sick person:

Date and time of the accident:

Place / company area:

Course of the accident:

Immediate consequences of the accident / illness

the injured person...:

Injured body parts:

Type of injuries:

Witnesses:

First aid measures

Date and time of the measures:

Type and manner of measures:

Material used:

First aider:

Data of the reporter (in case of queries)

Name of the reporting person:

Telephone number:

e-mail address: