Injury Report Form Template UK

The Injury Report Form Template UK is provided in multiple formats, including PDF, Word, and Google Docs, featuring customizable and printable examples.

Open – Template

Online – Template

Sample

Injury Report Form Template UK

Editable – Printable

PDF – 1 PDF – 2

Injury Report Form Template UK

1. Incident Information


2. Injured Party Information



3. Witness Information (if applicable)

4. Description of the Incident

5. Nature of Injury

6. Actions Taken Post-Incident

7. Reporting Supervisor

8. Additional Comments or Notes

9. Declaration



PDF

WORD

Examples

Injury Report Form Template UK (1)
Date of Incident:
[Date]
Time of Incident:
[Time]
Location of Incident:
[Location]
Name of Injured Person:
[Injured Person’s Name]
Address of Injured Person:
[Address]
Contact Number:
[Contact Number]
Details of Injury:
[Detailed Description of the Injury and Circumstances Leading to the Incident]
Witnesses:
[List of Witnesses and Their Contact Information]
Immediate Actions Taken:
[Description of First Aid or Other Initial Treatment Administered]
Follow-Up Required:
[Outline Any Needed Medical Follow-Up or Health Monitoring]
Reported By:
[Name of the Reporter]
[Position]
[Date of Report]
Signed:
[Signature of the Injured Person or Legal Guardian]
Injury Report Form Template UK (2)
Date of Incident:
[Date]
Time of Incident:
[Time]
Location of Incident:
[Location]
Name of Injured Person:
[Injured Person’s Name]
Address of Injured Person:
[Address]
Contact Number:
[Contact Number]
Nature of the Injury:
[Detailed Description of the Type of Injury (e.g., bruise, fracture)]
Cause of Injury:
[Detailed Account of How the Injury Occurred]
Witness Information:
[Names and Contact Details of Any Witnesses]
Actions Taken for Treatment:
[Explanation of Any Treatment Provided at the Scene]
Further Medical Assistance Required:
[Any Recommendations for Continued Care or Visits to a Healthcare Provider]
Submitted By:
[Name of the Person Filling Out the Report]
[Position]
[Date]
Signature:
[Signature of the Injured Person or Legal Guardian]

Printable

PDF – 1 PDF – 2

Injury Report Form Template UK