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
Name of Injured Person: | [Name] |
Job Title/Position: | |
Date and Time of Incident: | |
Location of Incident: | |
Description of Incident: | |
Injuries Sustained
Type of Injury/Illness: | Laceration |
Type of Injury/Illness: | |
First Aid Administration
First Aid Administered: | Cleaned and disinfected the wound, applied sterile bandage |
Person Administering Aid: | |
Date and Time of First Aid: | |
Additional Comments:
[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]
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