What is a Work Injury Report?
People quickly forget the details, but a Work Injury Report can help get the facts. Sometimes accidents aren't really accidental. Sometimes somebody was negligent. It doesn't really matter - at least right now - who's at fault. What matters is getting the facts written down. You don't want to stress out the person who's injured. They might be shaken up and not clearly remember what happened. The best way to get the truth is by asking the right questions as soon as possible. Make sure statements are written down. But how do you know the right questions to ask? Our Work Injury Report can help you make sure you've covered everything.
When to use a Work Injury Report:
- You were recently injured on the job.
- An employee was recently injured on the job.
WORKPLACE INJURY AND INCIDENT REPORT
Company Representative's Name:
Company Representative's Title:
Date of Birth:
Date of Hire:
Incident Case Number:
Date of Incident:
Time of Incident: Time cannot be determined
Employee's Workday Start Time:
Incident Investigation Date and Time:
Events Leading Up To the Incident:
Details of the Incident:
The Results of the Incident:
Objects or Substances involved in the incident:
Medical Treatment Required: was did
|Report Completed By:||_________________________________________|