Forms 301/417

Question 1

Sections of FORM 301

Answer 1

1. Employee Incident Information
2. Incident Basics
3. Witness Details
4. Incident/Accident Details
5. Recommended Corrective Action
6. Supplementary Documents
7. Save Draft, Load Draft, Submit
8. Medical Aid and Lost Time Details and Return to Work (WSIB information)

Question 2

Form 301
Who gets an email notification?

Answer 2

An Email Notification with a PDF copy of the Incident/Accident Report will be sent to the Supervisor/Manager detailed on the report, as well as the person who submitted the report. Also, an Email Notification will be sent to the individual(s) assigned the Corrective Action(s).

Question 3

Form 301
How many revisions? Who to contact if more are needed?

Answer 3

Form 301 will only allow for three revisions to be made. If any additional revisions are required, after the Supervisor/Manager has already made three revisions, contact your **Health & Safety Specialist **for the Form 301 to be updated accordingly.

Question 4

Form 417
Tabs?

Answer 4

1. Employee Details
2. Accident Occurrence
3. City Vehicle Details (Vehicle #1)
4. third Party Driver/Vehicle Details (Vehicle #2)
5. Witness Details
6. Police Information
7. City Vehicle Action
8. Occurrence Details
9. Accident Scene Drawing
10. Supplementary Documents
11. Save Draft, Load Draft, Submit
12. Managers/Supervisors ONLY - Report on Behalf of Employee –
13. Managers/Supervisors ONLY - Corrective Actions –

Question 5

Form 417
Mandatory third party driver details.

Answer 5

1. Name
2. Address, City,
3. Phone number
4. Drivers license number and expiration date
5. Driver injured?
6. Plate, Make, Model, Colour
7. Damage to third party vehicle?
8. Owner of third party vehicle (same as driver?)

Question 6

Form 417
Who to contact in an accident?

Answer 6

Police

Question 7

Form 417
How many revisions?

Answer 7

Please note the Form 417 will only allow for** three revisions **to be made. If any additional revisions are required, after the Manager/Supervisor has already made three revisions, contact your Safety Specialist for the Form 417 to be updated accordingly.

Question 8

Form 417
What must be done on form 417 to prevent further incidents?

Answer 8

a Corrective Action needs to be added by the Manager/Supervisor for every reported 417 to avoid a recurrence of the incident.