Template

Aqua Metro Services Incident and Injury Report Form

by Tania Salijevic, from the Community

20+

Use this Incident and Injury Report Form to document workplace incidents for Aqua Metro Services. Capture what happened, people involved, injury type and body part, causes, treatment given, time lost, and witness details. Log contributing factors like manual tasks, slips and trips, equipment, and environment. Record vehicle or property damage, investigation findings, and recommended corrective actions to prevent recurrence. Submit to your supervisor and the Health and Safety Manager for review and follow up.

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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
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
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
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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Template
SafetyCulture Incident and Injury Report Form
Use this customizable Incident and Injury Report Form to record workplace accidents, injuries, and near misses. Capture personal and incident details, witness information, injury specifics, and time lost. Includes an investigation checklist covering contributing factors, equipment condition, environment, PPE, surface types, and manual handling. WHS managers can add findings and assign corrective actions using the hierarchy of controls, with owners and due dates. Ideal for workshops and industrial sites, and adaptable across industries to improve safety and compliance.
by Darryl Bancale, from the Community
Downloads: 20+
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Aqua Metro Services Incident and Injury Report Form

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