Agricultural Machinery Injury Report Form
Date of Incident
Time of Incident
Location of Incident
Injured Person's Name
Age
Role/Job Title
Contact Information
Type of Machinery Involved
Machine ID/Serial Number
Brief Description of the Incident
Nature of Injury
First Aid Provided
Yes
No
Medical Attention Needed
None
Onsite Only
Clinic/Hospital
Witnesses (Names & Contact)
Additional Remarks