From the Rolls-Royce experimental archive: a quarter of a million communications from Rolls-Royce, 1906 to 1960's. Documents from the Sir Henry Royce Memorial Foundation (SHRMF).
Blank form for a foreman's report of an accident to a workman.
| Identifier | ExFiles\Box 142\3\ scan0020 | |
| Date | 23th November 1936 guessed | |
| FOREMAN'S REPORT OF ACCIDENT TO WORKMAN Name of injured person___________________________________ Check No.______________ Occupation_____________________________________________ Dept.___________________ Where did accident occur____________________________________________________ When accident happened: Date________________ Time________________ a.m. p.m. When ceased work as a result of accident: Date________________ Time________________ a.m. p.m. Nature of injury.____________________________________________________________ Cause of injury._____________________________________________________________ ___________________________________________________________________________ What exactly was the workman doing at the moment of accident:_____________________________________________ ___________________________________________________________________________ If caused by machinery state: (a) Name of machine:______________________________________________________ (b) Part causing injury:__________________________________________________ (c) Whether moved by mechanical power at the time:________________________ Names & check numbers of witnesses of accident:_____________________________________________________ ___________________________________________________________________________ If not witnessed, by whom injury first seen and when_____________________________ Date____________ Time____________ What has been done or is being done to prevent a recurrence (if nothing then state nothing) ___________________________________________________________ ___________________________________________________________________________ Signature of Foreman___________________ Date of signing______________________ | ||