Prüfplaner von Listico.de

Your rescuers

Report an incident

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Current language of the form is English

Eintragung ins elektronische Verbandbuch "Werkstatt Kernweg 4"

Information about the course of the accident or injury

Name of the injured or sick person :

Date and time of the accident :

Place / Department of the company:

Accident course:

Direct consequences of the accident / illness

The injured person... :

Damaged body parts :

Type of injury :

Witnesses:

First Aid Measures

Date and time of action :

Type and manner of action :

Used material:

First responder:

Data of the reporter (in case of questions)

Name of the reporting person :

Phone number:

Email address: