Register of Injuries Template - Free Download | Page 2
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Register of Injuries Template
Register of Injuries
Section 1: Injured worker details
Family name: First name:
Position: Department/team:
Manager/supervisor’s name:
Section 2: Injury/illness details
Date of injury/illness: Time of injury/illness: am/pm
Nature of injury/illness
Bodily location of injury/illness
Exaction location at time of injury
Describe how the injury/illness was sustained
Was any equipment involved in the injury/illness Yes / No (Please circle your response)
If yes, please provide details:
Section 3: Witnesses
Were there any witnesses to the injury/illness Yes / No (Please circle your response)
If yes, please list the witnesses’ full names as well as a contact number for each.
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Register of Injuries Template