Accident Report Form 1
Accident Report Form 2
PAST:
What was he doing?
What were they doing?
What was he doing?
What were they doing?
What happened?
What is this?
or What time is it?
or What time is it?
100
Who had an accident?
Maria Sanchez
100
Who had an accident?
Josclyn Roster
100
What was he doing last night?
He was cooking.
100
What happened?
He fell.
He fell off a ladder.
He fell from a ladder.
100
What time is it? (afternoon)
It is 2:00pm.
200
When did the accident happen?
October 1, 2025 at 2:55pm
200
When did the accident happen?
December 8, 2025 at 8:05am.
200
What was she doing this morning?
She was cutting vegetables.
200
What did he do after the accident?
He washed his hands.
200
What time is it? (evening)
It is 6:00pm.
300
Type of Injury:____________ (2 words!)
Sprained Wrist
300
Type of Injury:____________ (2 words!)
burned feet
300
What was he doing this morning?
He was fixing a car.
300
What did she do after the accident?
She went to the clinic.
300
What time is it? (Morning)
It is 5:45am.
400
How did the injury happen? Use SHE***
Explain.
She was climbing a ladder and fell on her wrist.
400
How did the injury happen? Use SHE*** 
She was cooking eggs and the pan feel. Oil got on her feet. She wasn't wearing sandals. She burned her feet.
400
What were they doing yesterday afternoon?
They were moving a couch.
400
What did he do?
He burned his hand.
400
What is this?
It is a bandage.
500
When did she sign the form?
October 2, 2025
500
TRUE OR FALSE: She signed the form the day AFTER the accident.
FALSE: She signed the form the same day.
500
What was he doing before he fell?
He was going up a ladder.
500
What did the doctor do?
The doctor put on a bandage.
500
What is this?
a) A ladder
b) A leader
A ladder
600
Which picture shows the accident?
A or B?
B
600
Which picture shows the accident? A or B?
A
600
What was he doing before he burned his hand?
He was welding.
600
What did she do after the accident?
She put ice on her foot.
600
What is this?
a) engine
b) pipe
c) tire
A pipe