VCP 421: Medicine Section

FORM III (refer Rule 12)

ACCIDENT REPORTING

1. Date and time of accident:
2. Sequence of events leading to accident:
3. The waste involved in accident :
4. Assessment of the effects of the accidents on human health and the environment:
5. Emergency measures taken:
6. Steps taken to alleviate the effects of accidents:
7. Steps taken to prevent the recurrence of such an accident:
8. Date ...............................
9. Signature ...........................................
10. Place..............................
11. Designation..........................................