Template

Firefighter Injury and Illness Investigation Report

by Terry Kaufman, from the Community

10+

This template is designed for fire departments to document and investigate firefighter injuries and illnesses. It captures key details including responder assignment, severity, destination, activity at time of injury, primary symptoms and affected body area, causes and contributing factors, specific location and circumstances, and any equipment failures. The form also includes narrative sections for witness details, incident description, medical treatment, duty status impacts, root cause analysis, and recommended corrective actions, with signatures for the injured person and safety officer.

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 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
Get
Template
Incident, Injury, Near Miss, Environmental Report Form
This incident report form helps teams document injuries, near misses, hazards, and any property or environmental damage that occurs on site. It captures key details including person and witness information, incident description, injury and treatment details, immediate and basic causes, contributing factors, and recommended corrective actions. The form also includes a structured risk assessment with consequence and likelihood ratings, plus manager sign-off and reporting fields for LTI and MTI. Use it to standardize workplace incident reporting and drive timely corrective action.
by Juan Rivera, from the Community
Downloads: 10+
Get
Template
Injury Report Form Template
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.
by Aparicio Perez, from the Community
Downloads: 0
Get
Template
Motor Mall Incident Report Full Investigation
Use this incident investigation report template to document incidents from first notification through root cause. Record incident details, timelines, environmental conditions, evidence and attachments, vehicle and equipment logs, damages, and people involved. Capture statements, injury types and body parts affected, and medical treatment. Perform root cause analysis, note contributing factors, and add corrective actions. Finish with sign off and follow up to close out the investigation.
by Liam Daniels, from the Community
Downloads: 0
Get

Firefighter Injury and Illness Investigation Report

About author

You might also like

Injury Investigation Form Template

Incident, Injury, Near Miss, Environmental Report Form

Injury Report Form Template

Motor Mall Incident Report Full Investigation

You might also like

Injury Investigation Form Template

Incident, Injury, Near Miss, Environmental Report Form

Injury Report Form Template

Motor Mall Incident Report Full Investigation