FORM EE
[See rule II]
REPORT OF FATAL ACCIDENTS

To
         ........... ………… …………. ………….
Sir,
         I have the honour to submit the following report of an accident, which occurred on (date) at (here enter details of premises) and which resulted in the death of the workman/workmen of whom particulars are given in the statement annexed.
2.  The circumstances attending the death of the workman/workmen were as under
(a) Time of the accident
(b) Place where the accident occurred
(c) Manner in which deceased was/were employed at time
(d) Cause of the accident
(e) Any other relevant particulars
I have etc.
(Signature and designation of person making the report.)
STATEMENT

Name

Sex

Age,

Nature of employment

Full postal address