FD-13A Accident Report Form

All accidents must be reported and investigated. Supervisors (Lieutenants, Captains & other supervisors) 
must complete this form and immediately contact an investigator. The immediate supervisor must complete 
this report immediately after the accident or near miss. In the absence of a supervisor the person having the 
accident should, if they are able, complete this form. The report must be submitted before the end of shift 
(career) or before leaving the fire station (volunteer).

This report has five parts. Everything you need to report a workplace accident, injury or near miss is 
included. You may check “not applicable” for parts that do not apply:

PART 1 – Who is reporting this accident or near miss? (must always be completed)
PART 2 – What happened? (must always be completed)
PART 3 – Injury Report
PART 4 – Motor Vehicle Collision Report
PART 5 – Exposure Report

Fill in all the applicable sections. Call your District Captain, Division Commander, Station Chief or other 
Supervisor to inform them of the accident so they may start an investigation. Email a copy of this report 
immediately to fsdiv@halifax.ca. If you don’t have access to email, fax a copy to 902-490-7114. Sign your 
report and give the signed original to your District Captain, Division Commander, Station Chief or other 
Supervisor.

If this accident resulted in serious injury, call dispatch and request them to notify the District Captain, 
Divisional Commander, and Divisional Chief of Safety immediately. 
At the accident scene:

• provide medical treatment for all injured persons.
• secure the scene to prevent further injury.
• protect the scene and evidence.
• keep witnesses at the scene for the investigator. If they refuse, record their names and contact information.
• Do not disturb the scene until internal and external investigators have approved.