Ship Crew Injury Report
Crew Member Details
Full Name
Rank / Position
Crew ID / Employee No.
Date of Birth
Nationality
Incident Information
Date of Incident
Time
Location on Ship
Activity at Time of Incident
Injury Details
Type of Injury
Part of Body Injured
Severity
Minor
Moderate
Serious
Description of Injury
Incident Description
Describe How The Incident Happened
Immediate Actions Taken
Describe Actions Taken
Witnesses
Witness Names (if any)
Person Reporting
Name
Position
Report Date