Injury Incident Report Form

Report injuries to employees, contractors or others using this basic Injury Incident Report form containing sections where to write down related information, acquire witnesses signatures, note measures applied, etc.

Injury Incident Report Form
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Incident Report Form Fields:

  • Status (Employee, Contractor or other)
  • Outcome (Injury or near miss)
  • Details of injured person (Contact details, work experience, etc)
  • Details of incident
  • Details of witnesses
  • Details of injury
  • Treatment administered
  • Did the injured person stop work
  • Incident inverstigation
  • Risk assessment
  • Actions to prevent recurrence
  • Actions completed
  • Review comments