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SafetyCulture
Template

Employees Report of Injury Form

by Enablement Team, from the Community

Downloads: 10+
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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.

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.