Workplace injury report form
A workplace injury is recorded by the person who saw it — a supervisor, a coworker, or the injured person themselves. This form logs the injury into your safety records the moment it happens. It is internal record-keeping that feeds into your safety program and incident trending. OSHA filing or insurance claims happen afterward, handled by your HR or safety team using this form as the intake.
The form beside this text is live. Fill it in and submit it — it validates exactly as it would for a real respondent, and saves nothing.
Timestamp precision for incident investigation
Date and time fields capture exactly when the injury occurred. This precision helps your safety team investigate conditions at that moment and identify patterns.
Witness information linked to the incident
Witnesses are recorded in the same form response that holds the injury description. Your safety team does not have to track down witness details separately — they arrive together.
No card required.
Workplace Injury Report Form
Live previewHow to build this form
5 steps in the editor. Nothing here needs a paid plan.
- Add fields for the date and exact time of the injury so the incident is timestamped precisely.
- Add a location field so you know where in the workplace the injury occurred.
- Add fields for the employee name and their supervisor, so you know who to follow up with.
- Add a long text field for a detailed description of what happened and how the injury occurred.
- Add fields for immediate action taken (first aid, emergency services, etc.) and optional witness information. Route to your safety team.
Fields in this form
8 fields, using 4 of the 19 field types available.
| Question | Field type | Required |
|---|---|---|
| Date of injury | Date | Yes |
| Time of injury | Time | Yes |
| Location | Short text | Yes |
| Employee name | Short text | Yes |
| Supervisor name | Short text | Optional |
| Describe the injury and how it occurred | Long text | Yes |
| Immediate action taken | Long text | Yes |
| Witness names (optional) | Long text | Optional |
What goes wrong with this form
Specific to a workplace injury report form, not general advice about forms.
Collecting the description but not the timestamp
Use separate date and time fields. "This morning" tells your safety team nothing about what conditions were present. A specific time lets them review records of that moment and investigate patterns.
Not recording the immediate action taken
Document what happened right after the injury: first aid applied, emergency services called, employee sent home, etc. This is part of the incident record and helps your safety team assess response quality.
Assuming the form filing completes the process
This is a record for your safety team to act on. Your HR or safety team still has to investigate, determine whether to file with OSHA or insurance, and follow up with the employee. The form is the starting point, not the finish line.
Questions about this form
What should a workplace injury report form capture?
Date, time, location, employee name, description of what happened, body part affected if known, immediate action taken, and optional witness names. This gives your safety team the core facts to log into your safety program and investigate what happened.
Is this form an OSHA report?
No. This is an internal safety record. Your safety or HR team reviews the report and decides whether OSHA or your workers' compensation insurance needs to be notified based on the nature and severity of the injury. The form is the intake, not the filing.
Who should fill out the injury report?
The person who witnessed the injury or the employee themselves if they are able. A supervisor can fill it out if the employee cannot. The important part is getting it on record as soon as possible after it happens.