Google-Plus
Facebook
Twitter
Pinterest
Linked In
YouTube
Instagram
search
United States
[Change]
Menu
Products
Ladders
Step Ladders
Extension Ladders
Rolling Scaffolds
Work Platforms
Ladder Accessories
Multi Ladders
Multi Position
Attic Ladders
Compact
Aluminum
Wood
Scaffolds & Planks
Rolling Scaffolds
Planks
Scaffold Components
Fall Protection
Harnesses
Lanyards
Retractables
Anchorage Connectors
Horizontal Lifelines
Vertical Lifelines
Compliance Kits
Confined Space
Drop Safety Equipment
Accessories
Specialty Products
Racks
Pump Jacks
Stages
Guard Rails
Featured Products
Fall Protection
LEANSAFE®
GLIDESAFE™ Extension Ladders
AERO™ Extension Ladders
ProForm Harnesses
R3 Concrete Anchor
Anchorage
Multi Position Ladders
Podium Ladders
Step Ladders with LOCKTOP™
LOCK-IN Ladder Accessories
Equalizer Ladders
Attic Ladders
Fall Protection
Safety
Safety Training
Schedule Safety Training
Ladder Safety Videos
Fall Protection Safety Videos
Safety Instructions
Support
Submit a Review
Replacement Parts
How To Choose a Ladder
Ladder Height
Performance System
Materials Matter
Unique Product Solutions
Literature
FAQs
Climbing Equipment
Fall Protection
Attic Ladders
Ladder Racks
Where To Buy
News
100 Years
News Releases
Featured Videos
Events
Sponsorships
Testimonials
ProZone
Recalls
Company
Profile
Why Werner
Innovation
Locations
Careers
Werner Gear
Asset Library
Contact Us
Company
Home
Incident Report
Incident Report
If you have been involved in an accident and suffered an injury with one of our products, please fill out the form below and someone will be in touch with you to review the details.
DATE OF THE INCIDENT:
INJURED PARTY’S NAME:
INJURED PARTY’S ADDRESS:
CITY, STATE, ZIP CODE:
EMAIL ADDRESS:
PHONE NUMBER:
BRIEF DESCRIPTION OF INCIDENT AND INJURY:
New code
Please type the code above
Submit
