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    Injury Report Form

    Uploaded by

    HOSAM HUSSEIN
    This injury report form documents an incident involving an employee of [Company Name]. It records the employee's name, job title, department, date and time of the incident, location, who it was reported to, and a description of what happened. The form also documents the employee's resulting injury, whether it was recorded on an OSHA form, where treatment was given, the type of treatment, and whether the employee can return to work and if so, when, or how many days off are required if not. The form is prepared and signed by the person documenting the incident.

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    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd

    Injury Report Form

    Uploaded by

    HOSAM HUSSEIN
    120 views2 pages
    This injury report form documents an incident involving an employee of [Company Name]. It records the employee's name, job title, department, date and time of the incident, location, who it was reported to, and a description of what happened. The form also documents the employee's resulting injury, whether it was recorded on an OSHA form, where treatment was given, the type of treatment, and whether the employee can return to work and if so, when, or how many days off are required if not. The form is prepared and signed by the person documenting the incident.

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    © Attribution Non-Commercial (BY-NC)

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    This injury report form documents an incident involving an employee of [Company Name]. It records the employee's name, job title, department, date and time of the incident, location, who it was reported to, and a description of what happened. The form also documents the employee's resulting injury, whether it was recorded on an OSHA form, where treatment was given, the type of treatment, and whether the employee can return to work and if so, when, or how many days off are required if not. The form is prepared and signed by the person documenting the incident.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    120 views2 pages

    Injury Report Form

    Uploaded by

    HOSAM HUSSEIN
    This injury report form documents an incident involving an employee of [Company Name]. It records the employee's name, job title, department, date and time of the incident, location, who it was reported to, and a description of what happened. The form also documents the employee's resulting injury, whether it was recorded on an OSHA form, where treatment was given, the type of treatment, and whether the employee can return to work and if so, when, or how many days off are required if not. The form is prepared and signed by the person documenting the incident.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 2

    Injury Report Form

    [Company Name]

    Employee Name:_______________________________________________________
    Job Title:______________________________________________________________
    Department:___________________________________________________________

    Date/Time of Incident:_________________________________
    Location:___________________________________________________________
    Date/Time reported:____________________________________
    Reported to:_____________________________________________________________
    Description of incident:___________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________
    Description of injury:
    ________________________________________________________________________
    ________________________________________________________________________

    Recorded on OSHA Form?


    Where was treatment given?_______________________________________________
    What type of treatment was given?__________________________________________
    Is employee able to return to work?_________________________________________
    If yes, when?_____________________________________________________________
    If no, how many days off are required:_______________________________________

    __________________________________________________________________________
    Prepared by (print)

    __________________________________________________________________________
    Signature

    ____________________________

    Date

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