Employee Accident/Injury Report Form

for Your State

Employee Accident/Injury Report which will effectively document the details of an employee's accident or injury while on the job. This form can easily be customized to fit your unique needs.

File types included

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  • Adobe PDF
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  • Rich Text Format

Compatible with

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  • Mac OS X
  • Linux

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This Employee Accident/Injury Report will clearly and efficiently document an injury or accident suffered by an employee while on the job. This report sets out details regarding the employee, date and time of the incident and type of accident or injury. It also sets out if medical attention was required. It is imperative that an on the job injury or accident be clearly documented. A written Employee Accident/Injury Report will prove invaluable in the event there are disagreements, misunderstandings or litigation resulting from the incident.

This Employee Accident/Injury Report includes the following information:
  • Employee: Employee's name, social security number, job title, date of hire and department in which he or she works;
  • Accident/Injury Information: Details regarding the date, time and location of the accident or injury, if medical assistance was necessary and remarks about the incident.

Protect your rights by using our forms which are up-to-date and prepared by attorneys.

This attorney-prepared packet contains:
  1. General Instructions
  2. Employee Accident/Injury Report
State Law Compliance: This form complies with the laws of all states
Number of Pages2
DimensionsDesigned for Letter Size (8.5" x 11")
EditableYes (.doc, .wpd and .rtf)
UsageUnlimited number of prints
Product number#29255

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