Warehouse Injury Workers’ Compensation File
Employee Name
Employee ID
Position/Job Title
Department
Date of Injury
Time of Injury
Location of Injury
Description of Incident/Injury
Type of Injury
Part(s) of Body Injured
Reported By
Date Reported
Supervisor Name
Witness(es)
Medical Provider (if applicable)
Treatment Details
Work Status (e.g., restricted, full duty, off work)
Claim Number (if assigned)
Insurance Company/Contact
Additional Notes