Run Grocery Store Employee Injury First Response Checklist — Free

Incident & Inspector Details

Incident date and time recorded critical (required)

Injured employee identified and work area documented critical (required)

Inspector name and role recorded critical (required)

Incident location within store documented

Brief description of how the injury occurred

Immediate Scene Safety

Area secured to prevent additional injury critical (required)

Yes No N/A

Hazards contributing to the injury identified and controlled critical (required)

Note (optional)

Spill, debris, or obstruction removed or isolated

Yes No N/A

Electrical, refrigeration, or equipment hazard isolated if involved critical (required)

Yes No N/A

Emergency services contacted if injury severity required escalation critical (required)

Yes No N/A

First Aid Response

First aid provided promptly by trained personnel critical (required)

Yes No N/A

First aid kit accessible and stocked for the response critical (required)

Yes No N/A

Bleeding controlled or wound protected critical (required)

Yes No N/A

Employee transported or referred for medical evaluation when needed critical (required)

Yes No N/A

Employee advised to report worsening symptoms or delayed onset pain

Yes No N/A

PPE used by responders as needed

Note (optional)

OSHA Recordable Determination

Initial recordable determination completed critical (required)

Note (optional)

Medical treatment beyond first aid was provided or requested

Yes No N/A

Note (optional)

Days away from work or restricted duty anticipated

Yes No N/A

Note (optional)

Needlestick, loss of consciousness, or other severe outcome present critical (required)

Yes No N/A

Supervisor or safety manager notified for recordkeeping review critical (required)

Yes No N/A

Documentation & Follow-Up

Incident report completed critical (required)

Yes No N/A

Witness names and statements collected if available

Yes No N/A

Note (optional)

Corrective action documented to prevent recurrence critical (required)

Supervisor notified and follow-up assigned critical (required)

Yes No N/A

Employee provided return-to-work or follow-up instructions

Yes No N/A

Note (optional)

Inspector signature completed critical (required)

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Run: Grocery Store Employee Injury First Response Checklist

Incident & Inspector Details

Immediate Scene Safety

First Aid Response

OSHA Recordable Determination

Documentation & Follow-Up

Get your results