The Work Place Injury Report Form is a crucial document required under Malaysian law, specifically the Occupational Safety and Health Act 1994 and related regulations. It must be completed whenever a workplace accident occurs resulting in employee injury or when there is a dangerous occurrence that could have led to injury. The form serves multiple purposes: it fulfills legal reporting requirements to authorities like DOSH and SOCSO, documents incident details for insurance and compensation claims, supports internal investigation processes, and helps identify preventive measures to avoid future incidents. The information collected includes employee details, incident circumstances, injury description, witness statements, and immediate actions taken, making it an essential tool for workplace safety management and compliance.
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.
Your data doesn't train Genie's AI
You keep IP ownership of your docs
1. Employee Information: Basic details of the injured employee including name, employee ID, department, job title, and contact information
2. Incident Details: Date, time, location, and type of incident
3. Injury Description: Nature and extent of injury, body parts affected, and immediate medical attention provided
4. Incident Description: Detailed account of how the incident occurred, including activities being performed and immediate causes
5. Witness Information: Names and contact details of any witnesses to the incident
6. Immediate Actions Taken: Emergency responses and immediate measures taken after the incident
7. Medical Treatment: Details of first aid administered and/or medical treatment sought
8. Supervisor's Statement: Immediate supervisor's account and verification of the incident
9. Declaration: Signatures of the employee, supervisor, and safety officer confirming the accuracy of the report
1. Equipment/Machinery Involved: Details of any equipment or machinery involved in the incident - required if incident involves machinery
2. Environmental Conditions: Description of workplace conditions at time of incident - required for incidents where environmental factors may have contributed
3. Personal Protective Equipment: Information about PPE used or required - necessary when incident involves PPE failure or non-usage
4. Previous Related Incidents: History of similar incidents in the workplace - included for recurring or pattern-indicating incidents
5. Foreign Worker Details: Additional information required for foreign workers under the Workmen's Compensation Act - required for non-SOCSO covered workers
1. Appendix A - Body Diagram: Diagram for marking location and type of injuries
2. Appendix B - Incident Scene Photographs: Photographic evidence of the incident scene and any relevant equipment or conditions
3. Appendix C - Medical Reports: Copies of initial medical assessment and treatment reports
4. Appendix D - Risk Assessment Form: Pre-incident risk assessment of the task/activity if available
5. Appendix E - Investigation Findings: Detailed investigation report if required by severity of incident
Find the exact document you need
Patient Safety Incident Reporting Form
A Malaysian-compliant standardized form for reporting and documenting patient safety incidents in healthcare settings, aligned with national healthcare regulations.
Download
Health And Safety Incident Report Form
A Malaysian-compliant Health and Safety Incident Report Form for documenting workplace incidents and accidents in accordance with DOSH regulations.
Download
Hazard Incident Report Form
A Malaysian-compliant workplace hazard and incident reporting form for documenting and investigating workplace safety events under local OSH regulations.
Download
Work Place Injury Report Form
A Malaysian-compliant workplace injury report form for documenting and reporting occupational accidents in accordance with local safety regulations.
Download
Employee Incident Report Form
A Malaysian-compliant workplace incident reporting form for documenting and investigating workplace accidents, injuries, and near-misses in accordance with local safety regulations.
Download
Critical Incident Report Form
A standardized form for reporting and documenting critical incidents in Malaysian workplaces, compliant with local safety regulations and DOSH requirements.
Download
Security Incident Report Form
A Malaysian-compliant security incident reporting form for documenting and managing security breaches and incidents under local data protection and cybersecurity laws.
Download
Incident Response Form
A Malaysian-compliant incident response documentation form for recording and reporting security incidents and operational disruptions.
Download
Incident Investigation Form
A Malaysian-compliant workplace incident investigation document for systematically recording and analyzing workplace incidents under OSHA 1994 requirements.
Download
ұԾ’s Security Promise
Genie is the safest place to draft. Here’s how we prioritise your privacy and security.
Your documents are private:
We do not train on your data; ұԾ’s AI improves independently
All data stored on Genie is private to your organisation
Your documents are protected:
Your documents are protected by ultra-secure 256-bit encryption
We are ISO27001 certified, so your data is secure
Organizational security:
You retain IP ownership of your documents and their information
You have full control over your data and who gets to see it
.png)