Free Work Injury Incident Report

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This Work Injury Incident Report is a must for every company or employer. This incident report thoroughly details a workplace injury, accident or illness. It contains details regarding the employee including name, date of birth and telephone number. It also contains a detailed description of the incident including the date, time and location, date incident was reported, by whom and if there are any witnesses. It is imperative that every work injury or illness be clearly documented in writing. A written Work Injury Incident Report will prove invaluable in the event there are disagreements, misunderstandings or litigation regarding a workplace injury or accident. This Work Injury Incident Report contains the following provisions: Company: Clearly sets forth the name of the company and that all incidents must be reported at least 48 hours following the incident; Personal Details: Name, age, gender, address and phone number of the employee who has been injured; Incident Details: Specific details regarding the injury including its cause, location, date and time and detailed description of the incident; Incident Reporting: Sets out who reported the incident, date and time it was reported and the person to whom it was reported (i.e., employer, manager or supervisor); Result/Witnesses: Sets forth if first aid was provided and if so, a description of the aid, any actions taken after the incident and the names and contact information of any witnesses to the accident or injury; Post-Investigation: If an investigation has commenced, sets forth the date of the commencement, investigating authority and the findings/recommendations of the investigation; Signatures: A manager or employer must sign and date this incident report. Protect your rights and your property by purchasing this attorney-prepared form. This attorney-prepared package includes: General Information Instructions and Checklist Work Injury Incident Report State Law Compliance: This form complies with the laws of all states