Template

Supervisor Injury Report Template (SIR)

by John Jachim, from the Community

10+

This Supervisor Injury Report (SIR) template helps supervisors capture complete details of a workplace injury or incident. Record employee information, date and time, exact location, how the event happened, contributing factors, photos, and witness statements. Assess potential severity and likelihood of recurrence, note PPE and training status, and document immediate and follow‑up corrective actions. Finish with supervisor signature and dates to support incident investigation and continuous safety improvement.

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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
Construction Incident Report Template
This construction incident report template helps teams capture critical details after a workplace incident. Record the date and time, report recipient, precise location, supervisor information, and witness names. Document persons involved, injury description, first aid or medical treatment, and OH and S reportable status. Log any property damage with photos and estimated costs, plus vehicle and equipment details. Add an in depth incident narrative including environmental conditions, immediate direct causes, contributing factors, and supporting photos. Define corrective actions with owners and due dates, assess potential severity and likelihood of recurrence, and collect signatures to complete the record.
by john hannan, from the Community
Downloads: 0
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Template
Non-Injury Incident Report Template
This non-injury incident report template helps supervisors and safety teams record workplace incidents that did not result in injury but caused damage or disruption. Capture key details such as date, time, location, persons involved, witnesses, and foreman. Document the nature of the incident, what was damaged, photos, estimated costs, and equipment or vehicle IDs. Record environmental conditions, immediate causes, contributing factors, and corrective actions with assigned responsibility. Assess potential severity and probability of recurrence, and finalize with signatures to support compliance and continuous improvement.
by Faye Meades, from the Community
Downloads: 20+
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Template
Injury Investigation - Initial
This initial injury investigation checklist helps supervisors document incident details, identify contributing factors, and define corrective actions to prevent recurrence. Capture worker information, time and location, injury type and body part, treatment, witnesses, and site conditions. Evaluate equipment, environment, human factors, methods, and PPE. Attach photos, record inspection findings, and assign responsible persons with due dates. Includes supervisor sign-off and health and safety manager comments.
by Rick Haertel, from the Community
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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
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Supervisor Injury Report Template (SIR)

About author

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Construction Incident Report Template

Non-Injury Incident Report Template

Injury Investigation - Initial

Injury Investigation Form Template

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Construction Incident Report Template

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