Free form template · Word

First Aid Incident Form

The first aid incident form is filled by the trained first-aider each time they treat someone at work, whether for a cut, burn, headache, fainting or allergic reaction. It records what happened, what treatment and supplies were given, and whether the person returned to work or was referred to a doctor.

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[Company Logo][Company Name]

FIRST AID INCIDENT FORM

Form No.:: [Reference Number]
Date:: [DD/MM/YYYY]
Time:: [Time]
Location:: [Work Location]

Person Treated

Name
Employee ID / Visitor / Contractor
Department / Company
Age
Contact Number

Complaint or Injury

Cut / abrasion
Burn
Sprain / strain
Eye irritation / foreign body
Fainting / dizziness
Headache / fever
Allergic reaction / insect bite
Other: [Details]

Brief description of what happened
Work-related? (Yes / No)
Body part affected

Treatment Given

Treatment given
Given by (first-aider name)
Time taken

Supply Used	Quantity	Restock Needed
[Sterile dressing / bandage]	[Number]	[Yes / No]
[Antiseptic solution]	[Number]	[Yes / No]
[Burn gel / cold pack]	[Number]	[Yes / No]

Outcome

Returned to work
Rested and returned to work after [Number] minutes
Sent home – HR informed
Referred to doctor / hospital: [Hospital Name]
Treatment refused (signature obtained)
Accident report form raised (No. [Reference Number])

I confirm that I received the first aid described above.

Person Treated
[Name]
Date: [Date]

First-aider
[First-aider Name]
Date: [Date]

Monthly First Aid Log

Date	Name	Complaint	Treatment	Outcome	First-aider
[DD/MM/YYYY]	[Name]	[Complaint]	[Treatment]	[Outcome]	[Name]
[DD/MM/YYYY]	[Name]	[Complaint]	[Treatment]	[Outcome]	[Name]
[DD/MM/YYYY]	[Name]	[Complaint]	[Treatment]	[Outcome]	[Name]

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What this template includes

Patient details, including visitors and contractors
Nature of complaint or injury, work-related or not
Treatment given and by whom
Supplies used, to trigger restocking
Outcome: back to work, sent home, referred to hospital
Link to accident report for work injuries
Monthly first aid log summary

When to use it

Treating a minor cut, burn or sprain on the shop floor
Attending to an employee who feels faint, dizzy or unwell
Giving first aid to a visitor or contractor
Restocking the first aid box based on supplies used

How to customise this template

1Keep a pad of forms inside or next to each first aid box
2List your first aid box contents in the supplies section
3Insert the nearest hospital and ESI dispensary
4Add a rule to inform HR if referral to doctor is needed
5Review the monthly log for repeated injuries in one area

HR tips

First-aiders should never give prescription medicines
Record refusals of treatment with the person's signature
Wear gloves when dealing with blood; record disposal
Escalate any head injury or eye injury to a doctor

First aid facilities and trained first-aiders may be required under the OSH Code, 2020 and state rules depending on headcount and process; verify current requirements.

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Frequently asked questions

Is a first aid register mandatory?+

Many factories and establishments are expected to maintain first aid facilities and records under applicable rules. A register is also good practice for tracking injuries.

Can a first-aider give painkillers?+

Company policy usually restricts first-aiders to basic first aid and no medicines, or only over-the-counter items approved by the medical officer. Check your policy.

When should a first aid case be reported as an accident?+

If the injury happened at work and needs medical treatment beyond first aid or causes absence, also complete the accident report form.

All 50 posh, workplace safety & compliance →

[Company Logo][Company Name]
WORKPLACE SAFETY INCIDENT REPORT
Incident No.:
[Reference Number]
Date of Report:
[Date]
Reported by:
[Employee Name], [Designation]
Part 1 – Incident Details
Date of incident [DD/MM/YYYY]
Time
Shift
Location / area / machine
Department
- Fire / smoke / explosion
- Electrical incident
- Chemical / gas / oil leak or spill
- Equipment, vehicle or machine failure
- Structural failure / falling object
- Injury to person (attach injury report)
- Property damage only
- Other: [Details]
Description: what happened, in sequence
Persons involved (name, ID, employee / contractor / visitor)
Witnesses (name, contact)
Part 2 – Immediate Action
Form · Word
Workplace Safety Incident Form
Download .docx
[Company Logo][Company Name]
COMPLAINT OF SEXUAL HARASSMENT AT THE WORKPLACE
To,
The Presiding Officer
Internal Committee, [Company Name]
[Company Address]
Email: [IC Email Address]

This form is confidential. You may attach additional sheets wherever space is insufficient.
Part A – Complainant Details
Full Name
Employee ID / Contractor / Visitor
Designation
Department
Work Location
Preferred Contact Number
Preferred Email
Best time and way to contact you
Part B – Respondent Details
Name of Respondent
Designation
Department / Organisation
Work Location
Relationship to you (manager, colleague, client, vendor, other)
Part C – Details of the Incident(s)
Form · Word
POSH Complaint Form
Download .docx
[Company Logo][Company Name]
POSH TRAINING FEEDBACK FORM
Session Date:
[DD/MM/YYYY]
Trainer:
[Trainer Name]
Batch / Location:
[Work Location]
Your feedback helps us improve. Writing your name is optional. Please do not use this form to report a complaint; contact the Internal Committee at [IC Email Address] or any committee member instead.
Section A – About You (optional)
Name (optional)
Department
Role level (Staff / Supervisor / Manager)
Employee or contract staff
Section B – Rate the Session (1 = Poor, 5 = Excellent)
Aspect 1 2 3 4 5
Content was clear and easy to understand
Examples were relevant to our workplace
Trainer handled questions well
Duration was appropriate
Language of delivery suited me
Form · Word
POSH Training Feedback Form
Download .docx
[Company Logo][Company Name]
ACCIDENT REPORT FORM
Report No.:
[Reference Number]
Establishment:
[Company Name], [Work Location]
Date of Report:
[Date]
A. Injured Person
Name
Employee ID / Contractor Name
Designation
Department
Age
Gender
UAN
ESI IP Number (if covered)
Contact Number
Emergency Contact informed (name, time)
B. Accident Details
Date of accident [DD/MM/YYYY]
Time
Shift and hours worked before accident
Exact place
Activity being performed
Machine / tool / vehicle involved
How the accident happened
PPE being worn at the time
C. Injury Details
Form · Word
Accident Report Form
Download .docx
[Company Logo][Company Name]
NEAR-MISS REPORT
Report No.:
[Reference Number]
Date:
[DD/MM/YYYY]
Time:
[Time]
Location / Section:
[Work Location]
Reported By (optional)
Name
Employee ID / Contractor Name
Department
Prefer to stay anonymous (Yes / No)
What Did You See?
- Unsafe condition (broken guard, spill, exposed wire, blocked exit)
- Unsafe act (no PPE, shortcut, bypassing safety device)
- Equipment / vehicle near-miss
- Falling or flying object
- Electrical / fire near-miss
- Other: [Details]
Describe what happened or what you saw
What could have happened?
Was anyone at risk? How many people?
Form · Word
Near-Miss Incident Report
Download .docx

Date of incident [DD/MM/YYYY]
Time
Shift
Location / area / machine
Department

Description: what happened, in sequence
Persons involved (name, ID, employee / contractor / visitor)
Witnesses (name, contact)

Full Name
Employee ID / Contractor / Visitor
Designation
Department
Work Location
Preferred Contact Number
Preferred Email
Best time and way to contact you

Name of Respondent
Designation
Department / Organisation
Work Location
Relationship to you (manager, colleague, client, vendor, other)

Name (optional)
Department
Role level (Staff / Supervisor / Manager)
Employee or contract staff

Date of accident [DD/MM/YYYY]
Time
Shift and hours worked before accident
Exact place
Activity being performed
Machine / tool / vehicle involved
How the accident happened
PPE being worn at the time

Describe what happened or what you saw
What could have happened?
Was anyone at risk? How many people?

[Company Logo][Company Name]

PRE-EMPLOYMENT MEDICAL EXAMINATION FORM

Form No.:: [Reference Number]
Date:: [DD/MM/YYYY]
Clinic / Doctor:: [Clinic Name]

Part 1 – Candidate Details (to be filled by HR)

Candidate Name
Date of Birth
Gender
Designation Offered
Department
Work Location
Expected Date of Joining
Job exposures (noise / dust / chemicals / heat / height / driving / night shift / food handling)

Part 2 – Health Questionnaire (to be filled by Candidate)

Question	Yes / No	Details
Any ongoing medical condition relevant to the job?		[Details]
Any surgery or hospitalisation in the last [Number] years?		[Details]
Regular medicines currently taken?		[Details]
Any hearing, vision or breathing difficulty?		[Details]
Any back, joint or mobility issue?		[Details]
Any allergy (medicines, dust, chemicals)?		[Details]
Any workplace adjustment you would like us to consider?		[Details]

Part 3 – Clinical Examination (Doctor)

Form · Word

Pre-Employment Medical Form

Download .docx

[Company Logo][Company Name]

ANNUAL / PERIODIC MEDICAL EXAMINATION FORM

Form No.:: [Reference Number]
Examination Year:: [Year]
Date:: [DD/MM/YYYY]
Examining Doctor:: Dr. [Doctor Name]

Section 1 – Employee and Exposure Details

Employee Name
Employee ID
Designation
Department / Section
Date of Joining
Main exposures this year (noise / dust / chemicals / heat / vibration / night shift / screen work)
Average working hours per week
PPE used regularly

Section 2 – Interval Health History

Since the last exam, have you had…	Yes / No	Details
New or worsening cough or breathlessness?		[Details]
Ringing in ears or difficulty hearing?		[Details]
Skin rashes or irritation?		[Details]
Back, neck or joint pain?		[Details]
Eye strain or headaches?		[Details]
Work injuries or sick leave over [Number] days?		[Details]

Section 3 – Year-on-Year Comparison

Form · Word

Annual Medical Examination Form

Download .docx

[Company Logo][Company Name]

DISABILITY ACCOMMODATION FORM

Ref. No.:: [Reference Number]
Date:: [DD/MM/YYYY]
Classification:: Confidential

Part 1 – Employee Details

Employee / Candidate Name
Employee ID
Designation
Department
Work Location
Reporting Manager

Part 2 – Disclosure (voluntary)

Nature of disability (optional, in your words)
UDID / disability certificate available (Yes / No / Prefer not to say)
Preferred format for communication (large print, email, sign language interpreter, other)

Part 3 – Barriers at Work

Form · Word

Disability Accommodation Form

Download .docx

Aspect	1	2	3	4	5
Content was clear and easy to understand
Examples were relevant to our workplace
Trainer handled questions well
Duration was appropriate
Language of delivery suited me

Name
Employee ID / Contractor Name
Designation
Department
Age
Gender
UAN
ESI IP Number (if covered)
Contact Number
Emergency Contact informed (name, time)

First Aid Incident Form

Preview of the form

Person Treated

Complaint or Injury

Treatment Given

Outcome

Monthly First Aid Log

What this template includes

When to use it

How to customise this template

HR tips

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Frequently asked questions

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