Employee injury incident report form

Include the injured employee’s details, date and time of incident, exact location, description of what happened, nature and extent of injuries, witnesses present, immediate actions taken, medical treatment provided, and any contributing factors like equipment failures or environmental conditions. Photos of the scene and injury can also strengthen documentation.

Typically, the injured employee’s supervisor completes the form with input from the injured person when possible. In some organizations, safety managers or HR representatives may take this responsibility. The injured employee should review the completed form for accuracy. Multiple perspectives ensure comprehensive documentation and help identify potential safety improvements.

Ensure your form captures all OSHA-required information including employee details, injury description, affected body parts, treatment provided, and work restrictions. Include fields for recording days away from work and job transfer details. Review OSHA’s Form 301 requirements as a baseline, and consider consulting with a safety professional for industry-specific compliance needs.

Injury incident reports document events that resulted in actual harm to an employee, while near-miss reports document potentially dangerous situations that didn’t cause injury. Both are valuable for safety improvement, but injury reports have additional compliance requirements. Using both reporting types creates a more comprehensive safety program that addresses problems before injuries occur.