Register of Injuries Template - Free Download | Page 3
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Register of Injuries Template
Section 4: Follow up
Was the injury reported to the workers supervisor Yes / No (Please circle your response)
Was any treatment provided Yes / No (Please circle your response)
If yes, please provide details.
Did the injured worker return to work following the injury Yes / No (Please circle your response)
If yes, please provide details.
Section 5: Details of person making this entry
Family name: First name:
Position: Department/section:
Signature: Date:
If you are not the injured worker, did you witness the injury/illness Yes / No (Please circle your response)
Section 6: To be completed by manager/supervisor of injured worker
Has an investigation been conducted into the incident Yes / No (Please circle your response)
What, if any, controls were implemented to ensure the incident doesn’t happen again
Section 7: Employer confirmation
I, (print name), of
(insert company name),
hereby confirm receipt of this notification.
Signature: Date:
Requirements of injury notification:
Employers must keep a Register of Injuries at each workplace for employees to record any workplace injury or
illness.
An injured worker (or someone acting on their behalf) must notify the employer in writing of any work-related injury or
illness within 30 days of becoming aware of the injury or illness.
Employers must provide written confirmation to the injured worker that they received notification of the injury or
illness.
Employers should provide a signed and dated copy of this entry to the injured worker.
To make a WorkSafe claim the injured worker must complete a Workers Injury Claim Form, available from the
Australia Post.
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