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FormFlow
Township of Lakewood
EMPLOYEE ACCIDENT / INCIDENT REPORT
🚗 Vehicle Accident
⚠️ General Incident
Main Department
-- Choose Department --
Public Works (DPW)
E.M.S.
Inspections
Police
Other
Employee Information
Date & Time of Incident
Location of Incident
Did this incident involve a Township or third-party vehicle?
Yes
No
🚗 Vehicle Information
Employee Statement
Supervisor Narrative / Description of Accident
Witness/Crew Member(s)
Describe Damage to Vehicle/Property
Were there injuries?
Yes
No
Describe the Injuries
Medical Treatment Status
-- Select Status --
First Aid Only (On Site)
Transported to Hospital / Clinic
Refused Medical Treatment
Transport Method
-- Select Method --
Ambulance
Self / Driven by Coworker
Not Transported
Police Action / Yellow Card
Supervisor Signature
Clear Signature
📄 Print
✅ Submit Report
