Crew Injury Report Template
Vessel & Voyage Details
Vessel Name
IMO Number
Date of Report
Voyage Number
Location (Latitude/Longitude or Port)
Injured Crew Details
Full Name
Rank/Position
Nationality
Date of Birth
Crew ID/Passport No.
Incident Details
Date of Incident
Time of Incident
Exact Location (e.g., Engine Room, Deck)
Weather/Sea Conditions
Brief Description of Incident
Nature of Injury
Type of Injury
Part of Body Injured
Description of Injury
Treatment & Actions Taken
First Aid/Treatment Given
Person(s) Providing Treatment
Was the Injury Reported to the Authorities?
Yes
No
Additional Actions Taken
Witness(es)
Name(s) of Witness(es)
Statement(s) of Witness(es)
Report Prepared By
Name
Rank/Position
Date