Ergonomic Injury Laboratory Incident Template
Name
Date of Incident
Department/Lab
Location
Detailed Description of Incident
Task Being Performed
Equipment/Tools Involved (if any)
Type of Ergonomic Injury
Muscle Strain
Repetitive Strain
Tendonitis
Other
Body Part Affected
Contributing Factors
Immediate Action Taken
Recommendations for Prevention
Reported By
Report Date