Template

Injury Report Form Template

by Aparicio Perez, from the Community

Use this OSHA aligned injury report form to document work related injuries, illnesses, or near misses from an employee perspective. Capture key details such as date and time, location, job role, witnesses, and a clear description of the event. Record affected body parts, medical treatment, and doctor information, along with contributing factors and what could have prevented the incident. Include corrective actions and follow up to support compliance and continuous improvement. Ideal for EHS and safety teams to standardize reporting and strengthen workplace safety programs.

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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
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
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
Downloads: 0
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Template
Accident Incident Report Template
Use this accident and incident report template to document workplace events from initial details to investigation. Record employee and site information, date and time, injury and body part, witnesses, medical treatment, severity and return to work status. Capture causes and contributing factors, corrective actions with responsible parties and due dates, and lessons learned. Include employee and witness statements and attach photos, drawings and training records to support the report.
by Steve Pope, from the Community
Downloads: 10+
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
Downloads: 10+
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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

10+

Get

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

Get

Template

Accident Incident Report Template

Use this accident and incident report template to document workplace events from initial details to investigation. Record employee and site information, date and time, injury and body part, witnesses, medical treatment, severity and return to work status. Capture causes and contributing factors, corrective actions with responsible parties and due dates, and lessons learned. Include employee and witness statements and attach photos, drawings and training records to support the report.

by Steve Pope, from the Community

10+

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

Injury Report Form Template

About author

You might also like

Employees Report of Injury Form

Event Incident Report Form

Accident Incident Report Template

Incident Injury Report Form Template

You might also like

Employees Report of Injury Form

Event Incident Report Form

Accident Incident Report Template

Incident Injury Report Form Template