Template

Injury Investigation Form Template

by Jonathan Nixon, from the Community

Use this injury investigation form to document a first report of injury or illness. Capture employee and incident details including date, time, location, injury type, and body part affected; eyewitness information; environmental conditions; underlying factors such as PPE use, equipment issues, and training gaps; and recommended corrective actions. Attach photos or media, assign actions, and record investigator and supervisor sign-off. Suitable for construction and other industries to support incident reporting and root cause analysis.

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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

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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
Injury Investigation - Initial
This initial injury investigation checklist helps supervisors document incident details, identify contributing factors, and define corrective actions to prevent recurrence. Capture worker information, time and location, injury type and body part, treatment, witnesses, and site conditions. Evaluate equipment, environment, human factors, methods, and PPE. Attach photos, record inspection findings, and assign responsible persons with due dates. Includes supervisor sign-off and health and safety manager comments.
by Rick Haertel, from the Community
Downloads: 0
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Template
Incident Injury Report Form Template
Use this Incident Injury Report Form to document workplace accidents and near misses. Record personal and incident details, witness information, injury type and body part affected, contributing factors, and site conditions. Includes an investigation checklist, risk controls (elimination, substitution, engineering, administration, PPE), and action tracking to prevent recurrence and improve WHS compliance.
by John Patrick Agustin, from the Community
Downloads: 10+
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Template
Incident Investigation Form
This incident investigation form helps supervisors and managers document workplace incidents the same day they occur. Capture incident type, department, location, date and time, witness details, and photos. Assess injury details including body part affected and nature of injury or illness. Identify causal and basic causes, perform a 5 Why root cause analysis, and note immediate corrective actions. Record OSHA classification, property damage, near misses, and high-potential events to support compliance and continuous improvement.
by Tyler Bonzo, from the Community
Downloads: 0
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Template
Incident/Injury Report Form
Use this Incident/Injury Report Form to document workplace events quickly and accurately. Capture personal and incident details, supervisor and WHS manager notifications, injury type and affected body part, treatment and time lost, and a full investigation checklist. Record contributing factors, equipment and PPE used, surface and environment conditions, manual handling actions, and preventive measures. Close the loop with corrective actions using the hierarchy of controls (elimination, substitution, engineering, administration, PPE), assign owners and due dates, and track recommendations to completion. Ideal for WHS compliance across industrial and field environments.
by Christina Edlaine De Jesus, from the Community
Downloads: 0
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Injury Investigation Form Template

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