Template

Injury Report Form

by Matt Griffiths, from the Community

10+

This Injury Report Form helps aquatic facilities, swim schools, and recreation centers document incidents involving employees or guests. Capture the incident date, time, exact location, mode and type of injury, activity prior to the event, and whether emergency services were called. Record details of all persons involved and witnesses, injury classification, affected body parts and sides, and contributing equipment. Document first aid consent, treatments provided (CPR, defibrillation, oxygen therapy, bleeding control, RICER), and DRSABCD assessments. Include medication administered, further treatment referrals, and sign-off by the shift supervisor to ensure accurate record keeping and follow-up.

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

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
Injury Investigation Form Template
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.
by Jonathan Nixon, from the Community
Downloads: 0
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Template
Employees Report of Injury Form
Use this Employees Report of Injury Form to report work related injuries, illnesses, or near miss events. The template guides employees to record incident date and time, witnesses, exact location, task being performed, sequence of events, contributing causes, and what could have prevented the incident. It also captures affected body parts, medical treatment details, provider information, and signatures from the employee and supervisor for follow up actions. Ideal for standardized incident reporting and hazard identification across workplaces.
by Enablement Team, from the Community
Downloads: 10+
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Template
Work Injury Report Template
Use this Work Injury Report template to document workplace incidents thoroughly and consistently. Record employer and employee details, date and time, location, type of injury, body part affected, activities at the time, equipment involved, and a narrative of how the event occurred. Log treatment provided, healthcare providers, hospitalization, witness details, and return to work dates. Support internal reporting, workers compensation, and safety compliance across industries.
by Dan Elwell, from the Community
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Template
Event Incident Report Form
Use this event incident report form to document what happened during an event and keep accurate records for safety and compliance. Capture event details, personal and contact information, injury type and affected body part, date and time, medical treatment provided (first aid, doctor, nurse, or hospital), provider information, and how the injury occurred. Include treatment date and time and secure a name and signature to complete the report. Ideal for event planners, venues, and hospitality teams who need a clear, consistent way to record incidents and follow up actions.
by Bryce Bukowski, from the Community
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Injury Report Form

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Injury Investigation Form Template

Employees Report of Injury Form

Work Injury Report Template

Event Incident Report Form

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Injury Investigation Form Template

Employees Report of Injury Form

Work Injury Report Template

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