Accident Investigation - After Report Form 4020 Question Title * 1. Today's Date: Date / Time Date Question Title * 2. This report is in relation to the accident/injury related to employee: Question Title * 3. The accident/injury date was: Date / Time Date Question Title * 4. Location of Original Incident (include address) Question Title * 5. Provide a brief recap of the accident/injury that occurred: Question Title * 6. Provide a description of the after accident investigation that occurred: Question Title * 7. What corrective actions have been proposed and discussed? Question Title * 8. Who has responsibility to ensure corrective actions have been properly deployed? Question Title * 9. Are there any outstanding issues related to this accident/injury that need to be reviewed? No Yes If Yes, provide details Question Title * 10. This report has been completed by: Question Title * 11. I certify the information provided is complete and accurate Yes I agree Question Title * 12. Is there any additional information to add? Done