About the Person & Injury

  • Date and Time of the Incident

  • Name of Injured Person

  • Injured Person's Department

  • Location Injury Took Place

  • Location if not listed in dropdown options

  • Location on body of injury

  • Exact location of injury - Example - left hand index finger

  • Type of injury

  • If Injury Type is not listed, please give details below

  • Attach photos of the injury - ensure permission is granted from the injured person before this is done

About the Incident

  • Please provide as much detail as possible about the incident which has caused the injury. Ensure the information entered is factual and not an opinion.

  • Give details of how the accident occurred - ensure this is the information provided to you by the inured person

  • where there any witnesses to the incident?

  • Provide names of witnesses

  • Provide the type of first aid treatment given

  • Location of injured person

  • Provide photos of the location of the incident

Sign off

  • Has the injured persons Line / Direct Manager been informed?

  • First Aider

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