15263-1910-Rules-under-the-Railways-Ordinance-1909-for-reporting-Accidents — Page 2

KOWLOON-CANTON RAILWAY.

(BRITISH SECTION.)

ACCIDENT REPORT.

Form E. No. 3.

546

THE HONGKONG GOVERNMENT GAZETTE, DECEMBER 16, 1916.

Locality

Name

· and

Brief

of

Time of Description.

persons

Nature of injuries as far as ascertainable and whether result-

Damage done to Permanent

Action taken

Person

Way or

Accident.

injured.

ing in death.

Property.

and

Nature of aid

rendered.

Cause

or

of Accident.

Persons

responsible.

Punishment

proposed.

Remarks.

Remarks

!

Signature of Officer fin warding report.

Signature of Subordinate submitting report.