Template

Agrodrain Medical Waiver Form

by Peter Affum, from the Community

20+

Use this medical waiver form to document when an employee chooses not to seek immediate medical treatment after a workplace incident. Capture key details including site information, site number, supervisor or foreman, employee name and position, and the date and time of the incident. Obtain employee and foreman signatures and dates. The form reinforces notifying the foreman and safety department before seeking treatment later, supporting incident documentation and injury management processes.

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Eliminate mistakes made by paper-based processes

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Confirm accountability and compliance with a digital log

With SafetyCulture you can

Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

About author

Community

This community page makes available free workplace checklists and templates created by other users within the SafetyCulture community. SafetyCulture has re-published this content and where possible, has credited the original author. SafetyCulture has not verified the accuracy, reliability or suitability of any community content. You agree that your use of any of this content is in accordance with SafetyCulture’s Terms and Conditions.

Template
Refusal for Medical Treatment and Observation Form
Use this form to record an employee decision to refuse medical treatment or observation after a workplace incident. Capture the incident date, preparer, employer details, confirmation that treatment or observation was offered in good faith, understanding of potential costs and lost wages, and the employee signature. Suitable for workplace health and safety documentation and incident follow up. Review and adapt to meet your requirements.
by Joshua Kelsey, from the Community
Downloads: 10+
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Site Incident Report Form
Use this site incident report form to document workplace events accurately and consistently. Capture site name, location, date and time of the incident and when it was reported, employee and supervisor details, witness names and contacts, and a clear description of the task and how the incident occurred. Record any damage or loss, immediate actions taken, photos of damage, and whether emergency services attended, including officer details. Assess post-incident risk, assign follow-up actions, and obtain employee and investigating manager signatures to support safety, compliance, and continuous improvement.
by Rick Todd, from the Community
Downloads: 30+
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LJ Keefe Foreman Incident Investigation Form
Use this LJ Keefe Foreman Incident Investigation Form to record and analyze workplace incidents on construction sites. The checklist guides foremen or managers to document key facts such as employee and jobsite details, incident class and type, date and time, hours worked prior, and the likely causes. It prompts capture of descriptions of the incident and resulting injuries, equipment involved, weather conditions, and PPE use. It includes space for witness names and statements, photos of the scene, and notes on any medical treatment, discipline, or post-incident drug and alcohol screening. The form concludes with recommended corrective actions and authorized representative signature to support root-cause analysis and continuous safety improvement.
by Roger Paveza, from the Community
Downloads: 0
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Template
First Aid Treatment Form
A comprehensive digital first aid treatment form designed for university first aiders and medical professionals. This template enables systematic documentation of casualty details, incident information, and medical treatments administered. The form includes sections for patient personal information, incident details, treatment records, medical referrals, and necessary signatures. It features options for referring patients to various medical facilities including A&E, GP, and University Medical Centre. The digital format allows for easy submission and record-keeping through email integration, making it an essential tool for maintaining accurate medical incident records in educational institutions.
by Paul Turnbull, from the Community
Downloads: 50+
Get

Refusal for Medical Treatment and Observation Form

Use this form to record an employee decision to refuse medical treatment or observation after a workplace incident. Capture the incident date, preparer, employer details, confirmation that treatment or observation was offered in good faith, understanding of potential costs and lost wages, and the employee signature. Suitable for workplace health and safety documentation and incident follow up. Review and adapt to meet your requirements.

by Joshua Kelsey, from the Community

10+

Get

Template

Site Incident Report Form

Use this site incident report form to document workplace events accurately and consistently. Capture site name, location, date and time of the incident and when it was reported, employee and supervisor details, witness names and contacts, and a clear description of the task and how the incident occurred. Record any damage or loss, immediate actions taken, photos of damage, and whether emergency services attended, including officer details. Assess post-incident risk, assign follow-up actions, and obtain employee and investigating manager signatures to support safety, compliance, and continuous improvement.

by Rick Todd, from the Community

30+

Get

Template

LJ Keefe Foreman Incident Investigation Form

Use this LJ Keefe Foreman Incident Investigation Form to record and analyze workplace incidents on construction sites. The checklist guides foremen or managers to document key facts such as employee and jobsite details, incident class and type, date and time, hours worked prior, and the likely causes. It prompts capture of descriptions of the incident and resulting injuries, equipment involved, weather conditions, and PPE use. It includes space for witness names and statements, photos of the scene, and notes on any medical treatment, discipline, or post-incident drug and alcohol screening. The form concludes with recommended corrective actions and authorized representative signature to support root-cause analysis and continuous safety improvement.

by Roger Paveza, from the Community

Get

Template

First Aid Treatment Form

A comprehensive digital first aid treatment form designed for university first aiders and medical professionals. This template enables systematic documentation of casualty details, incident information, and medical treatments administered. The form includes sections for patient personal information, incident details, treatment records, medical referrals, and necessary signatures. It features options for referring patients to various medical facilities including A&E, GP, and University Medical Centre. The digital format allows for easy submission and record-keeping through email integration, making it an essential tool for maintaining accurate medical incident records in educational institutions.

by Paul Turnbull, from the Community

50+

Get

Agrodrain Medical Waiver Form

About author

You might also like

Refusal for Medical Treatment and Observation Form

Site Incident Report Form

LJ Keefe Foreman Incident Investigation Form

First Aid Treatment Form

You might also like

Refusal for Medical Treatment and Observation Form

Site Incident Report Form

LJ Keefe Foreman Incident Investigation Form

First Aid Treatment Form