Sharps Injury Laboratory Report Form
Name of Injured Person
Position/Job Title
Department/Laboratory
Date of Injury
Time of Injury
Location of Incident
Type of Sharp Involved
Procedure/Activity at Time of Injury
Brief Description of Incident
Personal Protective Equipment (PPE) Used
First Aid Provided
Name(s) of Witness(es)
Date Reported
Reported To (Supervisor/Manager)
Corrective/Preventive Actions
Additional Comments