Please fill in this accident form if you have hurt yourself or had an accident while doing Whare Hauora work.

Name *
Name
Particulars of Accident
Date of accident
Date of accident
Time of Incident
Date Reported
Date Reported
The Injured Person
Name 1
Name 1
Address
Address
Date of Birth
Date of Birth
Volunteer? Contractor?
Type of Injury
Damaged Property
The accident
Provide a link to drawing of what happened if another car involved.
Analysis
How serious could it have been?
How often is it likely to happy again?