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Injury Report Template – Texas
Document severity, care, evidence, and vehicle details with this Texas injury report.
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Injury Report Template
[Organization / Employer / School / Program Name]
[Address]
[City, State, ZIP]
Phone: [Phone Number]
Email: [Email Address]
1. Immediate Response
Scene Secured: [Yes | No | N/A]
Hazard Controlled: [Stopped work | Isolated area | Shut down equipment | Traffic control | Other: ____ | N/A]
First Responder(s): [Name/Role]
On-Site Care: [Cleaned | Bandaged | Ice/cold compress | Pressure | Immobilized | Rest/observation | CPR/life support: ____ | Other: ____ | None]
EMS/911 Called: [Yes | No]
Time Called: [HH:MM a.m./p.m. / 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: [Address/Worksite/Route/Area]
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: ____]
Report Prepared Date: [MM/DD/YYYY]
3. Injured Person and Assignment
Full Name: [First, Middle, Last]
Role: [Employee | Contractor/Vendor | Visitor/Customer | Student/Child | Athlete/Participant | Other: ____]
Work/Activity Assignment: [Job/task/activity name]
Supervisor/Point of Contact: [Name, Title]
Phone/Email: [Phone ____ | Email ____]
4. Incident Narrative
Before:
[What was happening before the event]
Trigger:
[Change/event that started the incident]
Contact/Mechanism:
[How the injury occurred; objects/surfaces/vehicles involved]
After:
[What happened immediately after]
Immediate Response:
[Who responded and what actions were taken]
5. Injury and Severity
Body Area: [General area; avoid diagnosis: ____]
Side of Body: [Left | Right | Both | Center | Unknown]
Injury Type: [Bruise/Contusion | Cut/Laceration | Abrasion | Sprain/Strain | Suspected Fracture/Dislocation | Burn | Bite/Sting | Head Impact (suspected) | Other: ____]
Pain Score (0-10): [0-10]
Severity Scale: [S1 Minor/no time loss | S2 Needs evaluation | S3 Restricted activity | S4 Lost time | S5 Emergency/critical]
Severity Basis: [Observable facts supporting selected severity level]
6. Medical Follow-Up and Status
Transported for Care: [Yes | No | Declined]
Facility/Provider: [Hospital/Clinic Name / N/A]
Visit Date: [MM/DD/YYYY / N/A]
Restrictions Provided: [Yes: ____ | No | Unknown]
Status After Incident: [Returned to duty/activity | Modified duty/activity | Sent home | Off work | Other: ____]
7. Vehicle / Traffic Addendum
[Complete only if Setting Type = Roadway/Vehicle OR vehicle involved.]
Item | Details |
Vehicle 1 | [Year/Make/Model; VIN; Plate] |
Driver 1 | [Name; phone; license state/number] |
Vehicle 2 | [Year/Make/Model; VIN; Plate / N/A] |
Driver 2 | [Name; phone; insurer / N/A] |
Police/Report | [Agency; report #; responding officer; time] |
Direction/Intersection | [Free-text] |
8. Evidence Preservation
Photos: [Yes: IDs ____ | No]
Video/CCTV: [Yes: IDs ____ | No | Unknown]
Documents Collected: [Work order/training record/maintenance log/dispatch record/other: ____ | None]
Evidence Storage Location: [Drive/folder/case file; access owner]
Witnesses Present: [Yes | No | Unknown]
Witness 1 Name/Role: [____] Contact: [____] What Observed: [____]
Witness 2 Name/Role: [____] Contact: [____] What Observed: [____]
Witness 3 Name/Role: [____] Contact: [____] What Observed: [____]
9. Corrective Actions Summary
Immediate Fixes Made: [Free-text / None]
Follow-Up Owner: [Name, Title]
Target Completion Date: [MM/DD/YYYY]
Open Items: [Free-text / None]
10. Notifications and Signatures
Notified Parties: [Supervisor/Manager | HR/Safety | Parent/Guardian | Property Owner | Fleet/Transportation | Other: ____]
Notification Date/Time: [MM/DD/YYYY - HH:MM a.m./p.m.]
Notification Summary:
[Free-text]
Report Completed By: [Name; Role/Title; Signature; Date]
Supervisor Review: [Name; Signature; Date / N/A]
Case Owner Review: [Name; Signature; Date / N/A]
Fleet/Transportation Review: [Name; Signature; Date / N/A]
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Learn more about
Injury Report Template – Texas
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.
Texas Injury Report Template FAQ
What should be done first when there is an urgent injury at a worksite?
Address safety and medical needs first. Secure the area, stop the activity if needed, and call emergency services when appropriate. Provide basic first aid within your organization’s capabilities, then document who responded and what actions were taken. Once the situation is stable, complete the report while details are fresh. A timely, factual report is more valuable than a delayed perfect one, and you can add a dated update later if additional information becomes available.
How do you report an incident that occurred off-site or in the field?
Off-site incidents can be harder to verify, so location and access details matter. Capture the address, GPS coordinates if available, landmarks, and any entry or coverage issues that affected response time. Use a structured narrative so the sequence is understandable without local knowledge. If dispatch records, work orders, or route logs exist, record their identifiers in the evidence section. That makes it easier for reviewers to locate supporting records later without relying on informal recollections.
What information helps when a vehicle is involved?
Vehicle incidents benefit from consistent identifiers. Record year/make/model, VIN and plate, driver name and contact, and any police agency report number if one exists. Describe the roadway context, such as intersection, direction of travel, and traffic controls. Keep the narrative factual: where vehicles were positioned, what contact occurred, and what happened immediately after. If there are photos or video, reference the file IDs or camera identifiers so the evidence can be retrieved quickly.
How do you describe the mechanism of injury clearly?
A clear mechanism description identifies the source and the action. Note the object, surface, vehicle, or substance involved, and the movement or contact that produced the injury, such as slipped on a wet surface, struck by a moving item, collision, or twist while lifting. If there was a trigger event, like a sudden stop or loss of traction, include it. Avoid medical labels and focus on observable facts and the injured person’s reported sensations or limitations.
What is a practical way to rate severity without diagnosing?
Use observable outcomes instead of clinical conclusions. A simple scale can reflect whether the incident involved discomfort only, need for evaluation, restrictions on normal duties, missed time, or emergency transport. Then record the facts supporting that level, such as “immobilized on-site” or “transported by EMS.” This creates consistency across reports while avoiding diagnosis. If later documentation changes understanding, add a dated update explaining the new information and its source. Keeping the same scale language across teams also makes trend review and triage faster.
What if symptoms were reported later after the person kept working?
Delayed symptom reporting is common with strains, headaches, and some exposures. Record the incident time, the time symptoms were first reported, and what tasks were performed in the interval. Distinguish what the person remembers from what others observed. If CCTV or logs may clarify timing, list those identifiers before retention windows expire. A dated follow-up entry can capture changes in symptoms, work status, or restrictions without rewriting the original report.
Can one report cover multiple injured people?
It is usually cleaner to prepare a separate report for each injured person so symptoms, care, and follow-up actions are not mixed. Separate files also reduce priavacy risk and make later updates easier. If the incident is shared, link the reports using a common incident ID so reviewers can connect them. When a single initial report was created during a fast response, you can attach separate statements and then split the record into individual reports as soon as practical.
How can AI Lawyer help standardize reports across locations?
AI Lawyer can help you make section order, signature roles, and evidence fields consistent across multiple sites, so reports read the same way regardless of who completes them. That consistency reduces missing identifiers, makes follow-up tasks easier to assign, and helps compare incident patterns across locations. You can also tailor addenda like the vehicle block or remote access fields for teams that work in the field. After standardization, ensure each completed report is factual, complete, and dated when updated.
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