Free Workplace First Aid Incident Form Template
Workplace First Aid Incident Form
This Workplace First Aid Incident Form is a critical tool for promptly documenting and addressing injuries or illnesses in the workplace. Accurate completion ensures a swift response to maintain employee well-being and enhance overall workplace safety.
Incident Details
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Name of Injured Person: |
[Name] |
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Job Title/Position: |
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Date and Time of Incident: |
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Location of Incident: |
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Description of Incident: |
Injuries Sustained
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Type of Injury/Illness: |
Laceration |
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Type of Injury/Illness: |
First Aid Administration
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First Aid Administered: |
Cleaned and disinfected the wound, applied sterile bandage |
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Person Administering Aid: |
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Date and Time of First Aid: |
Additional Comments:
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[Name] was subsequently transported to the hospital for further evaluation and treatment. The machine has been temporarily taken out of operation pending a safety inspection. |
Completed By:
[Your Name]
[Job Title]
[Month Day, Year]
Reviewed By:
[Your Name]
[Job Title]
[Month Day, Year]
