REGULATION FOR COORDINATION OF ACTIVITIES ON WIND FARM Version 01: 20/10/06
ANALYSIS AND INVESTIGATION OF ACCIDENTS AND Page 1 of 1
WORK-RELATED ILLNESSES FORM Form RCA-12
CONTRACTOR INFORMATION: COMPANY NAME:
Contracted by:
PERSON SUFFERING THE ACCIDENT:
Name of employee:
Occupation:
INFORMATION REGARDING THE INCIDENT:
Date of incident: Day of the week: Time: Location of incident: Task being performed at moment of incident: Names of possible witnesses: Consequences: Incident Accident without Sick Leave Description of injuries to persons: Accident with Sick Leave Work-related Illness Accident Description of damage to things: