Injury Report Form Template

What Is It?

An injury report form is a document used to report workplace accidents or injuries. It is typically used by employees to inform their employer of any incidents that result in injury, and it is an important tool for tracking and managing workplace safety.

It is important to complete and submit the injury report form as soon as possible after the incident. This allows the employer to initiate an investigation, if necessary, and to provide any necessary support to the injured employee. In some cases, there may be legal or regulatory requirements for reporting workplace injuries, and failure to do so can result in penalties.

When To Use It?

An injury report form should be used whenever an employee experiences an injury in the workplace. This includes injuries sustained during work-related activities, such as operating machinery or lifting heavy objects, as well as injuries that occur on the job site, such as slips, trips, and falls.

The injury report form should be used regardless of the severity of the injury, whether it is a minor cut or a more serious injury, such as a broken bone or head injury. By reporting all injuries, employers can identify and address potential safety hazards in the workplace and ensure that employees receive prompt and appropriate medical attention.=

What To Include?

A typical injury report form includes the following information:

1. Employee Information: The name, job title, and contact information of the employee who was injured.
2. Date and Time of Incident: The date and time when the injury occurred.
3. Description of Incident: A detailed description of the circumstances surrounding the injury, including any relevant information about the cause, location, and type of injury.
4. Type of Injury: The nature and extent of the injury, such as a cut, burn, or broken bone.
5. Medical Treatment Received: Information about any medical treatment received, including the name and address of the treating physician or hospital.
6. Witnesses: The names and contact information of any witnesses to the incident.
7. Signature: The employee's signature indicates that the information provided is accurate and complete.