The Work Place Injury Report Form is a crucial document required by Pakistani labor law for documenting and reporting occupational accidents and injuries. It serves multiple purposes: ensuring compliance with federal and provincial safety regulations, facilitating workers' compensation claims, and contributing to workplace safety improvement initiatives. The form must be completed immediately following any workplace incident resulting in injury or potential injury, as mandated by the Factories Act 1934 and related provincial legislation. It contains detailed sections for recording incident circumstances, witness statements, medical attention provided, and follow-up actions taken. This documentation is essential for legal protection, insurance purposes, and maintaining occupational safety standards across Pakistani workplaces.
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1. Employee Information: Basic details of the injured employee including name, employee ID, department, 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 symptoms
4. Incident Narrative: Detailed description of how the incident occurred, including any equipment or materials involved
5. Witness Information: Names and contact details of any witnesses to the incident
6. Immediate Action Taken: First aid or medical treatment provided immediately after the incident
7. Medical Attention Details: Information about subsequent medical treatment, including facility name and attending physician
8. Supervisor's Review: Immediate supervisor's assessment and verification of the incident details
9. Safety Officer's Assessment: Evaluation by workplace safety officer including initial investigation findings
1. Environmental Conditions: Details about workplace conditions at the time of incident - used when environmental factors may have contributed
2. Equipment/Machinery Details: Specific information about equipment involved - required when machinery or tools were involved in the incident
3. PPE Assessment: Review of Personal Protective Equipment used - necessary when PPE was required for the task
4. Chemical Exposure Details: Information about chemical substances involved - required for chemical-related incidents
5. Third Party Involvement: Details of any contractors or visitors involved - used when non-employees are affected
6. Production Impact Assessment: Analysis of impact on operations - used for significant incidents affecting production
1. Appendix A - Body Diagram: Anatomical diagram for marking location and type of injuries
2. Appendix B - Photographic Evidence: Template for attaching and describing incident scene photographs
3. Appendix C - Medical Report Template: Standard format for medical assessment reports
4. Appendix D - Risk Assessment Form: Template for post-incident risk assessment
5. Schedule 1 - Emergency Contact List: List of emergency contacts and reporting procedures
6. Schedule 2 - Compensation Claim Checklist: Checklist for workers' compensation claim requirements
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