The Workplace Injury Report Form is a mandatory document required under South African law whenever an employee sustains an injury in the course of their work. This form must be completed in accordance with the Occupational Health and Safety Act (OHSA) and the Compensation for Occupational Injuries and Diseases Act (COIDA). It serves multiple purposes: documenting the incident for legal compliance, initiating compensation claims, identifying workplace hazards, and maintaining safety records. The form must be completed within 7 days of the incident and submitted to relevant authorities. It contains sections for personal information, incident details, medical information, and witness statements, forming a crucial part of both the employer's safety management system and the official injury reporting process.
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1. Employee Information: Personal details of the injured employee including ID number, employment details, and contact information
2. Employer Information: Company details, registration numbers, and relevant contact information
3. Incident Details: Date, time, location, and nature of the incident
4. Injury Description: Detailed description of the injury, affected body parts, and severity
5. Incident Narrative: Detailed account of how the incident occurred, including activities being performed
6. Witness Information: Names and contact details of any witnesses to the incident
7. Initial Medical Response: First aid or immediate medical attention provided
8. Medical Examination Details: Information about medical examination, treating doctor, and facility
9. Safety Equipment: Details of safety equipment in use at the time of incident
10. Declarations: Signatures of the employee, employer representative, and witnesses confirming accuracy of information
1. Vehicle Accident Details: Additional information required when the injury involves a vehicle accident
2. Machinery/Equipment Details: Specific information about machinery or equipment involved in the incident
3. Environmental Conditions: Details about weather, lighting, or other environmental factors relevant to the incident
4. Previous Related Injuries: Information about any previous injuries that may be relevant to the current incident
5. Third Party Involvement: Details of any third parties involved in or responsible for the incident
6. Temporary Disability Details: Information about temporary disability and expected return to work date
1. Medical Reports: Attached medical certificates, diagnostic reports, and treatment plans
2. Incident Scene Photos: Photographs of the accident scene, equipment involved, and visible injuries
3. Witness Statements: Detailed written statements from witnesses
4. Risk Assessment: Copy of relevant risk assessment for the task being performed
5. Training Records: Records of safety training relevant to the incident
6. Sketches/Diagrams: Drawings or diagrams showing the incident scene and sequence of events
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