The Injury Form Template – Australia is offered in multiple formats, including PDF, Word, and Google Docs. Each version is fully editable and printable, ensuring they cater to your specific requirements seamlessly.
Injury Form Template – Australia Editable | PrintableSample
1. Personal Information 2. Incident Details 3. Date and Time of Incident 4. Location of Incident 5. Witness Information 6. Description of Injuries 7. Medical Treatment (if applicable) 8. Additional Notes 9. Declaration and Signature
Generate PDF
Generate Word Document
Examples
[Employee’s Name]
[Employee’s ID]
[Department]
[Position]
[Contact Number]
Date of Incident: [Date]
Time of Incident: [Time]
Location: [Location of Incident]
A detailed description of the incident including what happened, how it happened, and any equipment involved.
Specify the type of injury sustained (e.g., cut, sprain, fracture) and severity (e.g., minor, moderate, severe).
Name: [Witness Name]
Contact: [Witness Contact Details]
Describe any first aid administered, and whether emergency services were called.
List any recommended follow-up actions, medical appointments, or further assessments.
[Employee’s Name] acknowledges the incident and describes their perspective.
[Employee’s Signature]
[Manager’s Signature]
[Employee’s Name]
[Employee’s ID]
[Position]
[Department]
[Contact Information]
Date: [Date]
Time: [Time]
Location: [Location]
Explain the circumstances leading to the injury, the sequence of events, and any contributing factors.
Indicate the specific injuries (e.g., abrasion, laceration) and classify the severity (e.g., first aid only, medical attention required).
Name: [Witness Name]
Contact Info: [Witness Contact]
Detail first aid measures taken immediately after the incident, including names of those who administered aid.
Outline any recommended steps for medical evaluation or treatment post-incident.
[Employee’s Name] provides a personal account of the incident and its impact.
[Employee’s Signature]
[Supervisor’s Signature]
Printable
