Free template
Injury Report Template – Washington
Document evidence, witness media IDs, symptoms, care, and head-impact screening in Washington.
Downloaded 2898 times
Download template
Injury Report Template
[Organization / Employer / School / Program Name]
[Address]
[City, State, ZIP]
Phone: [Phone Number]
Email: [Email Address]
1. Evidence and Documentation Capture
Initial Photos Taken: [Yes: IDs ____ | No]
Video/CCTV Source: [Camera IDs ____ | Bodycam ____ | Phone video ____ | None | Unknown]
Access Log / File Path: [Drive/folder/path; access owner]
Preservation Notes: [Free-text]
Witnesses
Witnesses Present: [Yes | No | Unknown]
Witness | Best Contact | Key Observation | Media/Link ID(s) |
[Name 1] | [Phone/Email 1] | [What seen/heard 1] | [Photo/Video ID(s) 1 / N/A] |
[Name 2] | [Phone/Email 2] | [What seen/heard 2] | [Photo/Video ID(s) 2 / N/A] |
[Name 3] | [Phone/Email 3] | [What seen/heard 3] | [Photo/Video ID(s) 3 / N/A] |
2. Incident Basics
Report/Incident ID: [Report/Incident ID]
Incident Date: [MM/DD/YYYY]
Incident Time: [HH:MM a.m./p.m.]
Location: [Room/Area/Worksite/Street]
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]
Setting: [Workplace | School/Childcare | Sports/Recreation | Public Place/Business | Roadway/Vehicle | Home/Residential | Other: ____]
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 (optional):
[Street Address]
[City, State, ZIP]
Best Time to Reach: [Days/Hours]
4. Event Narrative
Scene:
[What the area looked like; key objects/conditions]
Event:
[What occurred and who did what]
Mechanism:
[How the injury occurred; contact/exposure details]
Response:
[Actions taken immediately; who responded]
Follow-Up:
[Next steps known at time of report]
5. Symptoms and Functional Impact
Reported Symptoms: [Free-text]
Pain Score (0-10): [0-10]
Functional Limits: [Walking/standing/gripping/bending/vision/breathing/concentration/other: ____]
Observable Signs: [Bleeding | Swelling | Limping | Confusion | Shortness of breath | None observed | Other: ____]
6. Immediate Care and Medical Evaluation
On-Site Care: [Cleaned | Bandaged | Ice/cold compress | Pressure | Immobilized | Rest/observation | Other: ____ | None]
EMS/911 Called: [Yes | No]
Transported: [Yes | No | Declined]
Medical Visit After Scene: [Yes | No | Unknown]
Facility/Provider: [Name / N/A]
Restrictions: [Free-text / None / Unknown]
7. Evidence Checklist
Item Type | ID/Reference | Location/Source | Retention/Notes |
Photo | [Photo #/Link] | [Device/Folder] | [____] |
Video/CCTV | [Camera ID/Clip ID] | [System/Owner] | [____] |
Document | [Log/Record ID] | [Folder/Owner] | [____] |
Physical Item | [Item ID] | [Storage location] | [____] |
8. Head Impact Screening [Use only if head/neck involved OR sports/recreation setting]
Section Used: [Yes | No | N/A]
Head Impact Reported or Observed: [Yes | No | Unknown]
Observed Signs: [Loss of consciousness | Vomiting | Confusion | Severe headache | Neck pain | Other: ____ | None observed]
Removed From Activity: [Yes | No | N/A]
Return-to-Activity Plan: [Free-text / N/A]
9. Notifications and Signatures
Notified Parties: [Supervisor/Manager | HR/Safety | Parent/Guardian | Program Director | Other: ____]
Date/Time Notified: [MM/DD/YYYY - HH:MM a.m./p.m.]
Communication Summary:
[Free-text]
Case Owner: [Name; Title/Role; Signature; Date]
Supervisor Review: [Name; Signature; Date / N/A]
Safety Lead Review: [Name; Signature; Date / N/A]
Injured Person/Guardian Acknowledgment: [Name; Signature/Declined; Date / N/A]
Flash deal
Flash deal
Today
Today
No time to fill it up? Generate your custom agreement with AI Lawyer in seconds
What’s Included
Legal Research
Legal Research
Legal Research
Contract Drafting
Contract Drafting
Contract Drafting
Document Review
Document Review
Document Review
Risk Analytics
Risk Analytics
Risk Analytics
Citation Verification
Citation Verification
Citation Verification
Easy-to-understand jargon
Easy-to-understand jargon
Easy-to-understand jargon
Details
Learn more about
Injury Report Template – Washington
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.
Washington Injury Report Template FAQ
What is an Injury Report?
An injury report is a document used to record the facts of a workplace injury or incident in a clear, consistent way. It captures what happened, when and where it occurred, who was involved, and what immediate actions were taken, so the details aren’t lost or based on memory. The goal is to support timely follow-up, review, and prevention steps. Many workplaces use an injury report template to keep this information organized in the same format each time.
When should you complete an injury report?
You should complete an injury report any time an injury happens during work or a work-related activity — even if it seems minor at first. This is especially important if first aid is provided, medical attention is needed, a supervisor must be informed, or the incident could result in time off or work restrictions. Many workplaces also document near-misses when the situation could realistically have caused an injury. A simple rule: if it needs review, follow-up, or prevention steps, it should be reported.
What should an injury report include?
A good injury report should capture the essential facts in a neutral, easy-to-review way, so nothing important is missed during follow-up.
Date and time of the incident
Exact location (site/area/room)
People involved (injured person, supervisor, witnesses)
What happened (clear, step-by-step description of events)
Injury details (body part affected, symptoms observed or reported, visible signs)
Immediate actions taken (first aid provided, medical care sought, emergency response)
Contributing conditions (environment, equipment/tools, PPE, procedures, training)
Signatures and dates (to confirm review and accuracy)
Attachments (photos, diagrams, witness notes), if applicable
What should you do after completing an injury report?
First, submit the completed injury report to the correct person or department (manager, HR, or safety) following your workplace process. Next, ensure the injured person gets appropriate care and that any work restrictions or return-to-work steps are documented. Then review the incident to identify contributing factors and agree on corrective actions (fix hazards, update procedures, repair equipment, or retrain staff). Finally, store the report according to policy and follow up to confirm actions were completed and the risk is reduced.
Who should receive a completed workplace injury report, and when?
A completed workplace injury report should go to the person responsible for acting on it—typically the injured employee’s supervisor/manager first, then HR and/or the safety (EHS) team depending on your company process. It’s best to submit it as soon as possible after the incident (many workplaces aim for the same shift or within 24 hours) so details are accurate and follow-up can start quickly. If the injury is serious or requires medical treatment or time off, it should be escalated immediately according to your workplace reporting procedure.
In what situations is a first aid injury report form enough vs. a full report?
A first aid injury report form is usually enough when the injury is minor, treated on-site with basic first aid, and the person returns to normal duties with no medical referral and no time off. A full workplace injury report is typically needed when there’s medical treatment beyond first aid, ongoing symptoms, restricted/modified duties, or any lost time. It’s also better to complete a full report when the incident involves a serious hazard, equipment issues, multiple witnesses, or needs investigation to prevent repeat incidents.
Similar templates
Other templates from
Employment Legal Templates
Money back guarantee
Free trial
Cancel anytime
AI Lawyer protects
your rights and wallet
Money back guarantee
Free trial
Cancel anytime
AI Lawyer protects
your rights and wallet
Money back guarantee
Free trial
Cancel anytime
AI Lawyer protects
your rights and wallet
Money back guarantee
Free trial
Cancel anytime