Hotel Conference Room Furniture Injury Report
Injured Person Information
Name
Role / Affiliation
Phone
Email
Incident Details
Date of Incident
Time of Incident
Location (Room Name / Number)
Furniture Involved
Type (e.g., chair, table)
Furniture ID / Description
Injury Details
Describe the Injury
Body Part(s) Affected
First Aid or Medical Attention Administered?
Yes
No
If Yes, describe assistance given
Incident Description
Describe Exactly What Happened
Contributing Factors (if any)
Were there witnesses?
Yes
No
If Yes, list witness names & contacts
Reporter Information
Name
Date
Signature