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ESI Accident Report

ESI Accident Report

What is the Accident report?

The Employees’ State Insurance Corporation Form-12 for seeking Accident Report from Employer is available. Users must read the details as provided in the form and fill up as per the given instructions by the Employees’ State Insurance Corporation, Ministry of Labour and Employment, Government of India.

Who and when?

Employer shall submit an Accident Report to the branch office or ESI Dispensary concerned immediately in respect of accidents that could result in death or disablement of the employee within 24 hours of its occurrence. Minor accidents that do not cause absence from work need not be reported.

As and when the employment injury occurs, submit Accident report within 48 hours in ESIC Portal – Form 12

What information do you need to include in an accident report?

Contact Details

You will first need the injured party’s details; you need to collect as much as possible just if you may need it. Then you will need the casualties first and last name, telephone number, email address, home address, gender and date of birth. Then you need some details on why they were at the location and if they were an employee or a member of the public. Once the injured party has filled in their details, the person filling in the form will need to add their contact details to the record.

Accident and Injury Details

Next, you will need to gather some information on the accident itself and the damage it has caused; take down the date of the accident, the time and the location (try to be as specific as possible, e.g. which area of department or floor was the person on?).

All the details of the injury will then need recording; this could help make sure that you give the injured party the proper treatment if you gather enough information:

  • Type of injury suffered – laceration, burn, bruising, fracture?
  • What part of the body was injured?
  • Did the casualty require resuscitation or hospitalisation?
  • Did the casualty ever become unconscious?
  • How many days of work did the employee lose due to the injury?
  • Did an ambulance have to take the casualty from the scene?

Supporting Evidence

If a witness was on the scene, take their details and see if they will provide a written statement to support your cause. Other information such as photographs, CCTV footage, and Health and Safety Checks records are also valuable pieces of information.

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