Injury Report

Person Injured(Required)

First Last

Describe injuries sustained? E.g. burns, lacerations, bruises, broken bones etc.

Types of injuries to record:(Required)

BR Bruise

BU Burn

BB Broken Bone

CO Concussion

CL Cut / Laceration

DI Dislocation

FB Foreign Body

FR Fracture

IN Inflammation

IP Internal Pain

OW Open Wound

SP Splinter

RA Rash

P Puncture

O Other:

Please indicate and label the location of injuries sustained on the diagram below:

Has the person been involved in a similar incident before?

If an injury has been sustained, could this be a reoccurrence of a previous injury?

If so, what treatment has previously been given?

If this could be a reoccurrence of a previous injury please specify the date of the last incident:

On this occasion initial treatment/s if any, were given on / / by: e.g. N/A, First Aid, Ambulance, Hospital, Own Doctor etc(Required)

Reported / Recorded By:(Required)

Today’s Date is: 21/01/2026

Date(Required)

DD slash MM slash YYYY