Free Minor Injury Incident Report Form Template
Minor Injury Incident Report Form
Please fill out this form completely to document the details of a minor injury incident.
Employee/Individual Information
Name
Address
Phone number
Incident Details
Date and Time of Incident
Location of Incident
Description of Incident
Witness Name(s) (if any)
Witness 1 Name
Witness 2 Name
Injury Details
Type of Injury
-
Bruise
-
Sprain
-
Cut
-
Body Part(s) Affected
First Aid Administered
If yes, describe
Reported By
Name
Position/Role
Date
Signature
By signing below, I confirm that the details provided are accurate to the best of my knowledge.
Name:
Date:
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