FORM OF ACCIDENT REPORT. To the Commission of Gas and Electricity, Albany, N. Y.: Gentlemen. Pursuant to your directions, we hereby notify you of the following accident: Name of corporation.. Address of corporation. Name of person injured.. Age of person injured. Occupation of person injured.... Date of accident... Place of accident... Where taken after injury. . . . Probable duration of disability. Name of attending physician.. Address of attending physician... Was injured person obeying instructions at time of accident..... By whom were these instructions given.. Was accident due to negligence of injured person.. Give an exact and detailed description of the accident and its cause, supplementing by a sketch if same will make the explanation clearer. |