Work Place Injury Report Form Template for United Arab Emirates

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Key Requirements PROMPT example:

Work Place Injury Report Form

"I need a comprehensive Work Place Injury Report Form for our construction company in Dubai, UAE, that includes detailed sections for equipment-related incidents and can be completed digitally, while ensuring full compliance with UAE Labor Law and MOHRE requirements."

Document background

The Work Place Injury Report Form is a crucial document required under UAE labor legislation, specifically aligned with UAE Federal Law No. 8 of 1980 and MOHRE guidelines. This form must be completed whenever a workplace injury or accident occurs, serving multiple purposes including legal compliance, insurance documentation, and internal safety management. It captures detailed information about the incident, ranging from basic employee details to comprehensive accident descriptions and medical responses. The document is designed to meet strict UAE reporting requirements while facilitating proper incident investigation and prevention measures. It must be completed within the timeframe specified by UAE law and maintained as part of the organization's safety records.

Suggested Sections

1. Report Identification Details: Form number, date of report, and company identification details

2. Employee Information: Injured worker's personal and employment details including name, employee ID, nationality, position, and department

3. Incident Details: Date, time, location of incident, and type of injury/accident

4. Injury Description: Detailed description of the injury, affected body parts, and severity level

5. Incident Circumstances: Description of how the incident occurred, including activities being performed and immediate cause

6. Immediate Actions Taken: First aid or medical treatment provided, emergency responses implemented

7. Witness Information: Names and contact details of any witnesses to the incident

8. Medical Assessment: Initial medical evaluation, treatment provided, and recommended follow-up

9. Reporting Details: Names and signatures of person reporting, supervisor, and HSE representative

Optional Sections

1. Environmental Conditions: Details about weather, lighting, or environmental factors - relevant for outdoor incidents

2. Equipment Involved: Information about any machinery or equipment involved - necessary for technical incidents

3. PPE Assessment: Review of personal protective equipment used - important for incidents where PPE was relevant

4. Root Cause Analysis: Detailed analysis of underlying causes - for serious incidents requiring investigation

5. Lost Time Assessment: Evaluation of work time lost - needed for insurance and compensation claims

6. Previous Related Incidents: History of similar incidents - useful for pattern identification

Suggested Schedules

1. Medical Reports: Attached medical certificates, diagnoses, and treatment plans

2. Photographic Evidence: Photos of the incident scene, injury, or equipment involved

3. Witness Statements: Detailed written accounts from witnesses

4. Incident Scene Diagram: Sketches or diagrams showing the layout and incident location

5. Risk Assessment: Pre-existing risk assessment for the task/area involved

6. Training Records: Relevant safety training certificates of involved personnel

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co

Relevant legal definitions

Clauses

Relevant Industries

Construction

Manufacturing

Oil and Gas

Healthcare

Hospitality

Retail

Transportation

Logistics

Mining

Agriculture

Education

Facilities Management

Industrial Services

Warehousing

Maritime

Relevant Teams

Health and Safety

Human Resources

Operations

Risk Management

Compliance

Medical Services

Quality Assurance

Facilities Management

Employee Relations

Legal

Insurance

Relevant Roles

Health and Safety Manager

HR Director

Operations Manager

Site Supervisor

Facility Manager

Risk Management Officer

Compliance Officer

Department Head

Line Manager

Safety Coordinator

Medical Officer

Employee Relations Manager

Quality Assurance Manager

Project Manager

Senior Administrator

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Let's create your Work Place Injury Report Form

Authors

Alex Denne

Find the exact document you need

Security Guard Report Form

Health And Safety Incident Report Form

Hazard Incident Report Form

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Employee Incident Report Form

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Incident Response Form

Incident Investigation Form

Download our whitepaper on the future of AI in Legal

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