Template

Work Injury Report Template

by Dan Elwell, from the Community

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.

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
First Report of Injury (Form 45) Template
This First Report of Injury (Form 45) template helps retail teams document workplace incidents and workers compensation details. Capture employer and carrier information, employee demographics and wages, accident time and location, descriptions of how the injury occurred, affected body parts, treatment provided, and hospitalization status. Include physician details and signatures to complete a compliant incident report for store locations.
by Eric Zabinski, from the Community
Downloads: 10+
Get
Template
First Report of Injury Template
This First Report of Injury template helps employers document workplace incidents for workers compensation and safety compliance. Capture employer and carrier information, employee demographics, wages, job and hire date, accident date and location, activity at time of injury, description of how the incident occurred, affected body parts, and harmful objects. Record medical provider details, treatment location, emergency room and hospitalization status, and dates last worked or death if applicable. Includes fields for report preparer and signature to complete the incident record.
by Kelly Phillips, from the Community
Downloads: 10+
Get
Template
Injury Report Register
Use this Injury Report Register to document workplace injuries and illnesses in restaurants and quick-service environments. Capture worker details, position, store, manager, date and time, nature and body location of injury, exact location, description of how it occurred, and any equipment involved. Designed to support incident tracking and compliance across hospitality operations.
by Wayne Forrest, from the Community
Downloads: 20+
Get
Template
Weitsman Recycling Accident Report
This accident report form is tailored for Upstate Shredding–Weitsman Recycling locations to document employee injury incidents. It guides supervisors to record site location, date and time, employee details, hours worked, and whether a company vehicle was involved. It prompts photo evidence, incident narrative, witnesses and contacts, injury description, affected body part checklist, and how the injury occurred. Medical evaluation details include provider, transport, prescriptions, stitches, loss of consciousness, hospitalization, work restrictions, and return to work guidance. The form concludes with preparer information and signatures from the preparer and injured employee.
by Joan Roof, from the Community
Downloads: 10+
Get

First Report of Injury (Form 45) Template

This First Report of Injury (Form 45) template helps retail teams document workplace incidents and workers compensation details. Capture employer and carrier information, employee demographics and wages, accident time and location, descriptions of how the injury occurred, affected body parts, treatment provided, and hospitalization status. Include physician details and signatures to complete a compliant incident report for store locations.

by Eric Zabinski, from the Community

10+

Get

Template

First Report of Injury Template

This First Report of Injury template helps employers document workplace incidents for workers compensation and safety compliance. Capture employer and carrier information, employee demographics, wages, job and hire date, accident date and location, activity at time of injury, description of how the incident occurred, affected body parts, and harmful objects. Record medical provider details, treatment location, emergency room and hospitalization status, and dates last worked or death if applicable. Includes fields for report preparer and signature to complete the incident record.

by Kelly Phillips, from the Community

10+

Get

Template

Injury Report Register

Use this Injury Report Register to document workplace injuries and illnesses in restaurants and quick-service environments. Capture worker details, position, store, manager, date and time, nature and body location of injury, exact location, description of how it occurred, and any equipment involved. Designed to support incident tracking and compliance across hospitality operations.

by Wayne Forrest, from the Community

20+

Get

Template

Weitsman Recycling Accident Report

This accident report form is tailored for Upstate Shredding–Weitsman Recycling locations to document employee injury incidents. It guides supervisors to record site location, date and time, employee details, hours worked, and whether a company vehicle was involved. It prompts photo evidence, incident narrative, witnesses and contacts, injury description, affected body part checklist, and how the injury occurred. Medical evaluation details include provider, transport, prescriptions, stitches, loss of consciousness, hospitalization, work restrictions, and return to work guidance. The form concludes with preparer information and signatures from the preparer and injured employee.

by Joan Roof, from the Community

10+

Get

Work Injury Report Template

About author

You might also like

First Report of Injury (Form 45) Template

First Report of Injury Template

Injury Report Register

Weitsman Recycling Accident Report

You might also like

First Report of Injury (Form 45) Template

First Report of Injury Template

Injury Report Register

Weitsman Recycling Accident Report