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Workplace Injuries Report
Name of the personal Reporting the Injury.
Name:
Rank/Branch:
Name and Branch of the person who is Injured. [OPTIONAL Fill out if you aren't the one Injured.]
Name:
Rank/Branch:
Detailed Report on Injury/Does it affect Everyday duties?
Yes/No:
Report:
Do they require any Medical help? [EX: Splints, Surgery, Crutches, ETC.]
Answer:
Is the Injury Permanent? [EX. Leaves Scars, Constant Medical Attention, ETC.]
Answer:
Any Additional Notes.
Notes: