100%(2)2 out of 2 people found this document helpful
This preview shows page 1 - 3 out of 3 pages.
The Righteous Inn – Accident and Incident ReportInjured / ill worker’s detailsFirst name:HataipatLast name:PromjanDate ofbirth:02/05/1994Position:ChefDepartmentSydneyWorkersAddress148 Elizabeth St. Sydney NSW 2000Manager/supervisor’s name:Skye William Jane .Injury or illness detailsDate ofinjury/illness:05/08/2020Time ofinjury/illness:11:00 amam/pmNature of injury/illness:Knife cut fingers.Bodily location of injury/illness (for illnesses include symptoms):On a fingers. (Index and Middle fingers )Location at time of injury:In kitchen areas.How was the injury/illness sustained (cause of injury /illness):When she was slicing fruit. She picked up a glass of water in her uncomfortable hand. Then she distractedher and the knife cut her fingers.
Was any plant, equipment, substance or thing involved in the injury/ illness? If yes, please provide details:Fruit slicing knife .WitnessesWere there any witnesses to the injury/illness? Yes or No. If yes, please list name and contactnumber for each witness:YESName: