Free First Aid Incident Report

I. Incident Details

II. Injured Person Details

1. Name: John Smith

2. Phone Number: 555-123-4567

3. Position: Warehouse Supervisor

4. Medical History (if known):

   • Allergies: None

   • Previous Injuries: None

   • Medical Conditions: Hypertension (controlled with medication)

III. Incident Description

A. Description of Incident

While John Smith was in the process of transporting several heavy boxes within the confines of the warehouse, he stumbled over an extension cord that had not been securely fastened to the floor. This caused him to lose his balance, resulting in a fall that led to an injury to his right ankle.

B. Cause of Incident

• Lack of Proper Safety Measures: The fact that the extension cords were not properly secured created a situation where people could easily trip over them, thereby posing a tripping hazard.

• Inadequate Training: It is possible that the employees have not received sufficient training to effectively recognize and respond to potential risks and dangers that may be present in the workplace.

IV. First Aid Provided

A. Type of Injury/Illness

• Ankle Sprain: John Smith experienced significant discomfort due to pain, encountered noticeable swelling, and suffered from limited mobility in his right ankle.

B. First Aid Administered

1. RICE Protocol:

   • Rest: John Smith was instructed to stop working immediately and sit down to prevent further injury.

   • Ice: A cold pack was applied to his ankle for 20 minutes to reduce swelling.

   • Compression: The ankle was wrapped with a compression bandage to provide support and reduce swelling.

   • Elevation: [Your Name] (Injured Person) ankle was elevated above heart level to minimize swelling and pain.

2. Pain Management: John Smith was given ibuprofen, which is a form of pain relief medication available without a prescription, to ease the discomfort he was experiencing.

C. Person(s) Providing First Aid

• Sarah Johnson, a Certified First Aid Responder, promptly assessed and treated John Smith's ankle injury using the RICE protocol and pain relief medication. She ensured his comfort, safety, and communication, facilitating further medical attention as needed, which aided in his recovery.

V. Witness Statements (if applicable)

Witness 1:

"I was working nearby when I saw John trip over the extension cord. It happened so fast, and he fell right onto his ankle. Sarah rushed over immediately to help him."

- Emily Rodriguez

Witness 2:

"I heard a commotion and turned around to see John on the floor. It looked like he twisted his ankle pretty badly. Sarah was there quickly, providing first aid and making sure he was okay."

- Michael Thompson

VI. Follow-up Actions

• Recommendations: John should schedule an appointment with a healthcare provider for further evaluation of his ankle injury. Additionally, management should conduct a thorough inspection of the workplace to identify and address any potential hazards to prevent similar incidents in the future.

• Additional Notes: The incident highlights the importance of maintaining a safe work environment and ensuring that employees are trained to identify and mitigate potential risks.

VII. Report Completed By

1. Name: [Your Name]

2. Position: Health and Safety Officer

3. Contact Information:

   • Email: [Your Email]

   • Phone Number: 555-789-0123

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