Template

Injury Report Template

by Darryl Bancale, from the Community

10+

Use this Injury Report template to capture critical information after an incident, including patient demographics, medical history, AVPU consciousness level, pulse, breathing and skin observations, assessment notes, treatment provided, and follow-up referrals (ambulance, medical centre, own doctor). Designed for workplace first aid and safety recordkeeping.

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 and Illness Form
Use this Injury and Illness Form to document workplace incidents and first aid details. Capture worker details, medical history, AVPU responsiveness, pulse, breathing, skin color, and injury assessments including abrasions, fractures, bleeding, pain, swelling, and tenderness. Log treatments provided, comments, and follow up or referral to ambulance, clinic, or doctor. Download and customize to fit your organization safety reporting process.
by Kristine Joy Epe, from the Community
Downloads: 10+
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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+
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Template
First Report of Injury (Form 45) Template
This First Report of Injury (Form 45) template helps retail teams document workplace incidents and workers compensation details. Capture employer and carrier information, employee demographics and wages, accident time and location, descriptions of how the injury occurred, affected body parts, treatment provided, and hospitalization status. Include physician details and signatures to complete a compliant incident report for store locations.
by Eric Zabinski, from the Community
Downloads: 10+
Get
Template
First Report of Injury Template
This First Report of Injury template helps employers document workplace incidents for workers compensation and safety compliance. Capture employer and carrier information, employee demographics, wages, job and hire date, accident date and location, activity at time of injury, description of how the incident occurred, affected body parts, and harmful objects. Record medical provider details, treatment location, emergency room and hospitalization status, and dates last worked or death if applicable. Includes fields for report preparer and signature to complete the incident record.
by Kelly Phillips, from the Community
Downloads: 10+
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Injury and Illness Form

Use this Injury and Illness Form to document workplace incidents and first aid details. Capture worker details, medical history, AVPU responsiveness, pulse, breathing, skin color, and injury assessments including abrasions, fractures, bleeding, pain, swelling, and tenderness. Log treatments provided, comments, and follow up or referral to ambulance, clinic, or doctor. Download and customize to fit your organization safety reporting process.

by Kristine Joy Epe, from the Community

10+

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

Template

First Report of Injury (Form 45) Template

This First Report of Injury (Form 45) template helps retail teams document workplace incidents and workers compensation details. Capture employer and carrier information, employee demographics and wages, accident time and location, descriptions of how the injury occurred, affected body parts, treatment provided, and hospitalization status. Include physician details and signatures to complete a compliant incident report for store locations.

by Eric Zabinski, from the Community

10+

Get

Template

First Report of Injury Template

This First Report of Injury template helps employers document workplace incidents for workers compensation and safety compliance. Capture employer and carrier information, employee demographics, wages, job and hire date, accident date and location, activity at time of injury, description of how the incident occurred, affected body parts, and harmful objects. Record medical provider details, treatment location, emergency room and hospitalization status, and dates last worked or death if applicable. Includes fields for report preparer and signature to complete the incident record.

by Kelly Phillips, from the Community

10+

Get

Injury Report Template

About author

You might also like

Injury and Illness Form

First Aid Treatment Form

First Report of Injury (Form 45) Template

First Report of Injury Template

You might also like

Injury and Illness Form

First Aid Treatment Form

First Report of Injury (Form 45) Template

First Report of Injury Template