Laboratory Eye Injury Incident Report
Date of Incident
Time of Incident
Name of Person Reporting
Role
Name of Injured Person
Role/Position
Location of Incident
Activity Being Performed
Description of Eye Injury
Cause of Injury
PPE in Use at Time of Incident
First Aid / Immediate Action Taken
Further Medical Treatment Required?
Yes
No
Witnesses (if any)
Recommended Preventive Actions
Date Reported