Injury Report Form HR
Injury Report Form
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Your Full Name: |
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Address: |
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Phone Number: |
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Email: |
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Date and Time of Injury: |
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Describe the injury: (Include details about how, where, and when the injury occurred) |
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Were there any witnesses? |
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If yes, provide their details: (Include their full name, contact details and relationship to you) |
Description of how the injury had occurred:
Employee Statement:
Recommendations/Actions Taken:
Preventive Measures:
Disclaimer:
By submitting this form, I confirm that the information provided is accurate to the best of my knowledge. I understand that false information may lead to disciplinary actions.
