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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
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.
How do you write a clear, objective workplace injury report?
To keep an injury report clear and objective, write a short, factual timeline of what happened using observable details: the time, exact location, the task being performed, and the sequence of events. Use simple language, stick to what is known (and note what isn’t), and include direct quotes if they help clarify what someone said or felt. Avoid adding opinions or conclusions—save “why it happened” for the investigation section, if your workplace uses one.
What wording should you avoid in a workplace injury report?
In a workplace injury report, avoid blame, judgment, and assumptions—phrases like “careless,” “at fault,” “should have known,” or “obviously,” as well as statements that guess the cause (“the equipment failed” or “they were distracted”) unless you can confirm it as a fact. Also avoid vague language like “hurt badly” or “slipped somehow”; replace it with specific, measurable details (what surface, what action, what body part, what symptoms). Keep the tone neutral and factual so the report stays useful for review and follow-up.
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