Template

Injury and Illness Form

by Kristine Joy Epe, from the Community

10+

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.

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 Report Template
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.
by Darryl Bancale, from the Community
Downloads: 10+
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Template
MGI-INJURY AND ILLNESS REPORT
2019 This Injury and Illness Report is one of the first forms you must fill out when a recordable work-related injury or illness has occurred.
by Hugo Salmeron, from the Community
Downloads: 40+
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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
Incident, Injury, Trauma and Illness Record
This incident, injury, trauma and illness record template helps education and childcare services document essential details when a child is harmed or unwell. Capture child information, incident time and location, witnesses, nature of injury or illness, first aid and treatment provided, emergency services attendance, and steps taken to prevent recurrence. Record notifications to parents or guardians, directors or coordinators, regulatory authorities, and other agencies, plus parental acknowledgement. Use this form to support regulatory compliance, improve safety, and strengthen reporting practices.
by Mark Whyte, from the Community
Downloads: 0
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Injury Report Template

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.

by Darryl Bancale, from the Community

10+

Get

Template

MGI-INJURY AND ILLNESS REPORT

2019 This Injury and Illness Report is one of the first forms you must fill out when a recordable work-related injury or illness has occurred.

by Hugo Salmeron, from the Community

40+

Get

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

Get

Template

Incident, Injury, Trauma and Illness Record

This incident, injury, trauma and illness record template helps education and childcare services document essential details when a child is harmed or unwell. Capture child information, incident time and location, witnesses, nature of injury or illness, first aid and treatment provided, emergency services attendance, and steps taken to prevent recurrence. Record notifications to parents or guardians, directors or coordinators, regulatory authorities, and other agencies, plus parental acknowledgement. Use this form to support regulatory compliance, improve safety, and strengthen reporting practices.

by Mark Whyte, from the Community

Get

Injury and Illness Form

About author

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Injury Report Template

MGI-INJURY AND ILLNESS REPORT

Injury Investigation Form Template

Incident, Injury, Trauma and Illness Record

You might also like

Injury Report Template

MGI-INJURY AND ILLNESS REPORT

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Incident, Injury, Trauma and Illness Record