Template

HFA Injury Report V1

by Peter Brunt, from the Community

10+

Use this injury report template to document workplace incidents thoroughly. Record the injured worker details, supervisor, location, injury type and body part, activity at the time, witness statements, and first aid provided. Include notifiable incident categorization for SafeWork NSW, site preservation, insurer notification, transport to hospital, and required signatures. Supports compliance and improves safety reporting.

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
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
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
Accident/Injury Incident Report Template
This accident and injury incident report template helps teams document workplace incidents thoroughly. Capture incident type, hazard source, specific body part injured, and the activity being performed at the time. Record employee and witness statements, first aid administered, whether off-site medical treatment was required, and who assisted. Track required PPE and safety procedures (e.g., LOTO, machine safeguards), note if they were used, and explain deviations. Identify contributing factors such as equipment, job procedures, layout, time pressure, lack of PPE or training, and outline corrective and preventive actions with responsible parties. Includes validation and sign-off fields for employee, supervisor, safety coordinator, and investigation team members.
by Jason Madsen, 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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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

Get

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

10+

Get

Template

Accident/Injury Incident Report Template

This accident and injury incident report template helps teams document workplace incidents thoroughly. Capture incident type, hazard source, specific body part injured, and the activity being performed at the time. Record employee and witness statements, first aid administered, whether off-site medical treatment was required, and who assisted. Track required PPE and safety procedures (e.g., LOTO, machine safeguards), note if they were used, and explain deviations. Identify contributing factors such as equipment, job procedures, layout, time pressure, lack of PPE or training, and outline corrective and preventive actions with responsible parties. Includes validation and sign-off fields for employee, supervisor, safety coordinator, and investigation team members.

by Jason Madsen, 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

HFA Injury Report V1

About author

You might also like

Work Injury Report Template

Incident Injury Report Form Template

Accident/Injury Incident Report Template

Injury Investigation Form Template

You might also like

Work Injury Report Template

Incident Injury Report Form Template

Accident/Injury Incident Report Template

Injury Investigation Form Template