Laboratory Injury/Accident Documentation Template
Date of Incident
Time of Incident
Location (Lab/Room Number)
Name of Injured Person
Position/Role
Contact Information
Description of Incident
Apparent Cause
Nature and Extent of Injury
First Aid / Medical Treatment Provided
Corrective Actions / Preventive Measures
Reported To (Supervisor/Authority)
Date Reported
Witnesses
Signature of Preparer
Date