Injury Investigation ReportPlease enable JavaScript in your browser to complete this form.Name of injured person *Date of birthTelephone numberAddressGenderMaleFemaleWhat body part(s) were injured? Describe in detail. *What was the nature of the injury? Describe in detail.Describe fully how the accident happened? What was the employee doing prior to the event? What equipment, tools, etc were being used? *Names of all witnesses:Date / Time of eventDateTimeExact location of eventWhat caused the event? *What could have been done to prevent the injury?Employee went to doctor/minor emergency/hospital? *YesNoDoctor/minor emergency/hospital nameName of submitting employee *MessageSubmit
