Injury Investigation Form
Please fill out this form to provide details about the injury.
Injured Person
First Name
Last Name
Date and Time of Injury
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Location of Injury
Description of Injury
Cause of Injury
Severity of Injury
Please Select
Minor
Moderate
Severe
Were there any witnesses?
Yes
No
Witness
First Name
Last Name
Evidence
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