Free Customer Injury Report Form Template
Customer Injury Report Form
Please fill out this form completely to document any injury involving a customer.
Date
Incident Location
Customer Name
Please provide your email address.
Phone Number
Type of Injury
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Slip/Trip/Fall
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Cut or Laceration
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Burn
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Body Part(s) Injured
Specify injured area(s).
Was medical attention required?
Detailed Account of Incident
Provide a clear and concise explanation of what occurred, including how the injury happened and any contributing factors.
Immediate Actions Taken
Describe steps taken to assist the injured customer and prevent further harm.
Relevant Files or Documents
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Supervisor |
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