Injury Report Form / Reporte de Incidente 

Please take a moment to review your responses and ensure all information is complete and accurate before submitting your Injury Report.

By submitting this form, you certify that the information provided is true and complete to the best of your knowledge. Knowingly providing false, misleading, or incomplete information may result in disciplinary action and may be referred to the appropriate authorities when applicable.

If this is a medical emergency, notify your supervisor immediately and seek emergency medical assistance.

Thank you for helping us maintain a safe workplace.