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Injury Report Template – Florida
Log incident phases, injuries, care, evidence, and follow-up with this Florida template.
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Injury Report Template
[Organization / Employer / School / Program Name]
[Address]
[City, State, ZIP]
Phone: [Phone Number]
Email: [Email Address]
1. Setting and Conditions
Primary Location: [Room/Area/Field/Worksite/Street/Other]
Remote/Outdoor or hard-to-access location? [Yes/No]
[If Yes, complete the fields below.]
GPS Coordinates: [GPS Coordinates]
Nearest Cross-Street/Landmark: [Nearest Cross-Street/Landmark]
Access Notes: [Gate code/entry point/boat access/other]
Closest Facility (distance/time): [Closest facility name + distance/time]
Surface Condition: [Dry | Wet | Sandy | Uneven | Obstructed | Slippery | Other: ____]
Lighting/Visibility: [Normal | Low | Glare | Night | Other: ____]
Weather: [Clear/rain/wind/heat/cold/other: ____ | N/A]
Cleaning/Work in Progress: [Yes: ____ | No | Unknown]
2. Incident Basics
Report/Incident ID: [Report/Incident ID]
Incident Date: [MM/DD/YYYY]
Incident Time: [HH:MM a.m./p.m.]
Setting Type: [Workplace | School/Childcare | Sports/Recreation | Public Place/Business | Roadway/Vehicle | Home/Residential | Other: ____]
Report Prepared Date: [MM/DD/YYYY]
3. Injured Person Information
Full Name: [First, Middle, Last]
Role: [Employee | Student/Child | Athlete/Participant | Visitor/Customer | Contractor/Vendor | Other: ____]
Date of Birth: [MM/DD/YYYY]
Phone/Email: [Phone ____ | Email ____]
Address:
[Street Address]
[City, State, ZIP]
4. Activity Context
Activity at Time of Event: [Free-text]
Footwear/Equipment: [Free-text / N/A]
Crowding/Traffic Level: [Low | Moderate | High | Unknown | N/A]
5. Incident Narrative
Phase 1 - Lead-up:
[Free-text]
Phase 2 - Initiating Event:
[Free-text]
Phase 3 - Contact/Mechanism:
[Free-text]
Phase 4 - Immediate Effects:
[Free-text]
Phase 5 - Actions Taken:
[Free-text]
6. Symptoms and Injury Details
Primary Symptom Cluster: [Pain | Swelling | Bleeding | Dizziness | Nausea | Numbness/tingling | Shortness of breath | Other: ____]
Pain Score (0-10): [0-10]
Body Area: [Free-text]
Visible Signs: [None | Redness | Swelling | Bleeding | Deformity | Limited motion | Other: ____]
Reported Symptoms:
[Free-text; use injured person words where possible]
7. Immediate Care and Disposition
Responder(s): [Names/roles]
Care Provided: [Cleaned | Bandaged | Ice/cold compress | Pressure | Immobilized | Rest/observation | Other: ____ | None]
EMS/911 Called: [Yes | No]
Transported: [Yes | No | Declined]
Facility Name: [Hospital/Clinic Name / N/A]
Status After Incident: [Returned to activity | Restricted | Sent home | Transported | Other: ____]
Medical Visit After Scene
Medical Visit After Scene: [Yes | No | Unknown]
Medical Follow-Up Item | Details |
Provider/Facility | [Name / N/A] |
Visit Date | [MM/DD/YYYY / N/A] |
Restrictions/Notes | [Free-text / None / Unknown] |
8. Corrective Actions Log
Action Item | Owner | Due Date | Status | Reference |
[Free-text] | [Name/Role] | [MM/DD/YYYY] | [Open/In progress/Complete] | [Ticket/Link/Other] |
[Free-text] | [Name/Role] | [MM/DD/YYYY] | [____] | [____] |
[Free-text] | [Name/Role] | [MM/DD/YYYY] | [____] | [____] |
[Add rows as needed.]
9. Evidence Preservation
Witnesses
Witnesses Present: [Yes | No | Unknown]
Witness/Contact | What Seen/Heard |
[Name 1; phone/email 1] | [One-sentence summary 1] |
[Name 2; phone/email 2] | [One-sentence summary 2] |
[Name 3; phone/email 3] | [One-sentence summary 3] |
Photos: [Yes: IDs ____ | No]
Video/CCTV: [Yes: IDs ____ | No | Unknown]
Scene Sketch/Map: [Yes: ____ | No]
Evidence Storage: [Drive/folder/case file; access owner]
10. Notifications and Signatures
Notified Parties: [Supervisor/Manager | HR/Safety | Parent/Guardian | Property Manager | Other: ____]
Date/Time Notified: [MM/DD/YYYY - HH:MM a.m./p.m.]
Summary of Communication:
[Free-text]
Report Completed By: [Name; Role/Title; Signature; Date]
Operations/Program Review: [Name; Signature; Date / N/A]
Safety Coordinator Review: [Name; Signature; Date / N/A]
Injured Person/Guardian Acknowledgment: [Name; Signature/Declined; Date / N/A]
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Learn more about
Injury Report Template – Florida
Click below for detailed info on the template.
For quick answers, scroll below to see the FAQ.
Click below for detailed info on the template.
For quick answers, scroll below to see the FAQ.
Florida Injury Report Template FAQ
Do you need an injury report for a minor slip with no visible injury?
Many organizations document minor events because symptoms can appear later and scene conditions can change quickly. A brief report can capture the time, location, surface condition, and the person’s initial statement even if there is no visible injury. That record helps identify repeat locations and supports consistent follow-up if the person later reports pain, swelling, or dizziness. The report does not need to be long to be useful, but it should be factual and completed as close to the incident as reasonably possible.
How can wet surfaces or cleaning activity be documented without assigning blame?
Stick to observable details: the surface type, whether it appeared wet or slippery, any warning cones or signage present, and any cleaning activity that was observed. If someone reports that cleaning occurred earlier, record it as a reported statement and note the source. Avoid conclusions about why the condition existed or who caused it. This approach preserves scene context for follow-up while keeping the report neutral and readable. If cones, mats, or signage were present, note their location and whether they were visible from the approach path.
What if the incident happens at an outdoor venue or near water?
Outdoor settings often require better location detail than a room number. Document the nearest cross-street, entrance, or identifiable landmark, and include GPS coordinates if available. Note weather, footing (sand, wet decking, uneven paths), and whether access constraints affected response time. If the location is part of a larger venue, describing the route to the spot helps responders and reviewers find the same area later. Photos taken from fixed reference points can also improve clarity.
Why include an action log before an investigation is complete?
An action log tracks practical follow-up items and simple controls while facts are still being gathered. It can include temporary steps, such as blocking access to a slick area, and longer-term tasks, such as maintenance checks or training refreshers. Logging actions is not the same as determining fault; it documents ownership, due dates, and status. This reduces the risk that early safety steps are forgotten once the immediate situation resolves.
Which attachments tend to help the most during follow-up?
Photos of the area, camera identifiers for CCTV, and references to relevant logs are often the most useful because they allow others to understand the scene quickly. If a scene sketch or map helps explain the path of travel, include it or reference where it is stored. If the injured person voluntarily provides medical discharge paperwork or restrictions, referencing it can support consistent scheduling decisions. Use clear file IDs so attachments can be retrieved without searching.
What if a parent or guardian cannot be reached right away?
Document attempts to reach the guardian, including method and time. If another authorized contact is available, record who was reached and what was communicated. Do not delay necessary care while waiting for contact; instead, document care provided and the disposition. If the guardian later provides additional information, such as restrictions, add it as a dated update. Clear notification notes reduce confusion and demonstrate that reasonable communication steps were taken. If you leave a voicemail or send a message, record that method and any callback received, then add a dated update once contact is made.
Can the same report support internal tracking and later insurance follow-up?
Yes, especially when the report separates the factual narrative from administrative fields and evidence references. Internal reviewers often focus on conditions and prevention, while insurers may focus on identifiers, contacts, and medical disposition. A well-structured report can serve both by capturing who, what, where, and immediate outcomes, then listing evidence IDs and follow-up actions. If new information arrives later, add a dated supplement so the record shows what was known at each stage.
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