Cryogenic Burns Incident Report
Incident Details
Date of Incident
Time of Incident
Location of Incident
Brief Description of Incident
Injured Person Details
Name
Role/Position
Contact Information
Injury Information
Area of Injury
Severity of Injury
Minor
Moderate
Severe
First Aid Administered
Witnesses
Name(s) of Witnesses
Follow-Up Actions
Actions Taken After Incident
Reported To (Name & Position)
Date Reported