WEEKLY INCIDENT-ACCIDENT REPORT FORM

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Weekly Incident-Accident Report Form

Following is some critical injury or damaged details that may occur at your site or facility. While investigating, observing, preparing, and reporting any such dangerous occurrences, consider and remember these key points, then it will be easier for you to investigate or record that situation.

This article also highlights what parts of the body could be injured, affected, and pose serious physical injuries.

This weekly incident-accident report form should be completed whenever an unwanted occurrence (accident or incident occurs) results in any minor or critical physical injury or damage to or property. If personnel, property, or assets were not injured or deteriorated during the Accident/ Incident, do not use this incident-accident report form. For that purpose, you must use the Near Miss Report Form.

A. Details of injury/damage

• Bruising, contusion
• Concussion
• Internal injuries
• Open wound
• Abrasion, graze
• Amputation
• Open fracture (i.e. bone exposed)
• Closed fracture
• Dislocation 
• Sprain, torn ligaments
• Suffocation, asphyxiation
• Gassing
• Drowning
• Poisoning
• Infection
• Burns, scalds, and frostbite
• Effects of radiation
• Electrical injury
• Property damage,

B.The parts of the body that are most seriously injured 

• Head, except eyes                                    
• Fingers, one or more
• Eyes                                                             
• The hip joint, thigh, knee cap
• Neck                                                            
• The knee joint, lower leg, ankle
• Back, spine                                                 
• Foot
• Chest                                                           
• Toes, one or more
• Abdomen                                                   
• Extensive parts of the body
• Shoulder, upper arm, elbow                  
• Multiple injuries
• Lower arm, wrist, hand                            
• Other, Specify 

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