Abf accident report

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Abf accident report

  1. 1. AliBoo Farm Inc. Accident/Incident ReportPerson/s or Property Involved: (circle one) Date & Time of Accident/Incident:Horse Involved: Y/N Location:If yes, list name, age, breed:Person Involved in Occurrence: List Name/s and Pertinent Information: (Use separate paper for multiple)Name:Address:Telephone Contact Name & Number:Date of Birth:If minor involved, was parent present? Y/N (circle one) If yes, list name of parent:If parent was not present at time of occurrence, time of notification and by whom:Was there an Injury? If so, list type of injury:Has Injured Party Received Prior Instruction? Y/N (circle one) If yes, explain details below:Activity at Time of Accident/Incident:Other Conditions in Effect at Time of Accident/Incident (weather):
  2. 2. 1st Aid Required: Y/N (circle one)If Yes, Given By:Medical Services Required: Y/N (circle If Yes, Clinic/Hospital Name & Location:one)Medical Services Received: Basic 1st Aid Xray Stitches Hospital Admission OtherDid Injured Return to Previous Activity: Y/N (circle one) If no, provide explanation below.List All Witnesses: 1) 2)Name & Telephone 3) 1)Names of AllEmployees 2)Present/Involved in 3)Accident/Incident: Notes: Name:Person Filling OutReport Information: Address: JF TF AF Telephone: Other Email:Signature: Date Submitted:Corrective Action Required: Y/N (circle one) If yes, describe recommendation below.Corrective Action Taken: Y/N (circle one) If yes, describe action taken below.Date Action Taken:Report reviewed by ABF Management Team: Y/N (circle one)Date of Review:

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