Incident Reporting Software >> Injury Report Form
Published 05/10/2021

Injury Report Form

An injury report form is a critical form in the workplace incident management process that is often the first front line report of what has actually occured when an injury has happened. It might be filled out by a witness, the first person to attend and provide help, an observer, the injured person themselves or a manager / staff member. An injury report can be filled out for any type of injury and in any type of work or non work environment. It might be a sports club or public facility where an injury has happened to a member of the public or it might be a contractor, visitor or employee injury.

It's the injury report form that can help determine the heart beat of how safe a workplace is. If lots of injury reports are happening in a certain area, department, site or facility, the trends and analysis of these injuries can lead to major change in the workplace to prevent those injuries from happening in the future. But it is all starts with a good injury report form and procedure!

What to include on an Injury Report Form

In a fast paced mobile world, obviously one of the best ways to deliver an injury report form is online and on mobile. From tablets to phones for an injury report app, you can set up an online form for your staff to report an injury in the workplace. The common fields to include:

Capture of the details of the Injury / Illness
The severity
The type of injury
The nature of the injury
The mechanism
What were the causes
What treatment was done
Dates, hospital details and much more

Commonly for a mobile based injury report form, the idea is to make it short and sweet so that front line staff can quickly capture what has happened, how and even take a photo.

Injury Report Template

Here is a sample injury report form template commonly used fo reporting an injury in the workplace and its severity

Site
Time
Department
Date of incident
Name of person logging this incident
Position
Who was this incident reported by
Who was this incident reported to
Preliminary Incident Investigation

Nature of Injury
Fractures
Sprains & Strains
Cuts & Abrasions
Laceration
Concussion
Mental
Foreign Body
Skin
Infection
Head Injury
Internal system/organs
Bruising
Injury location
Burns & Scalds
Occupational Disease
Mechanism of Injury
Slips, Trips & Falls
Manual Handling
Hitting Object
Being Hit By Object
Bullying / Harassment
Heat
Electricity
Chemicals
Environment
Hand Tools / Knives
Power Tools

First name
Last name
Phone
Address
Injury or Illness Sustained By
Detail Any time lost
Was there any lost work time

Injury or Illness Severity


Please describe this incident in detail
Exact location
Initial Treatment Details
Description of the Injury or Illness

Full Library of Injury Report Forms

Use our ready to go injury report template or create your own personalised form using our form builder.

Pick the injury forms that best suit your unique needs

Create your own forms online from scratch!

What injuries need to be reported?

There are many legislative requirements that demand you record and manage injuries in the workplace. An incident does not have to be fatal to be reported. It could be a near miss, an observation or a minor injury. Capturing injury reports allows you to manage the risks, causes and controls with the aim of preventing the injury from happening again.

What to know about building your own form

Using our injury report form builder you can add a new field, move them around, edit, delete and within seconds you'll have created a custom injury report form tailored to how you want your users to submit incidents and to the specific information you want to collect for your organisation.

Best way to deliver an injury report form

Online, mobile, via an app, these are all the best mediums to ensure that injuries are captured when they happen and that they are reported at all in the first place! Using these best practice technology mediums, you can ensure your workforce is armed with the tools to report all injury reports as they happen in the workplace.

Sample Injury Report Form