STAFF INJURY REPORT Report injury to your supervisor immediately. Please enable JavaScript in your browser to complete this form.Injured Person's Name *Report Author *Email *Injury Date / Time *DateTimeInjury Location *JasperSafeOtherSpecific Location *CastleCrystal CreekRanch HouseDepotSchoolCovered StructureBarnPorchOther (specify in detail below)Injury Occurred During *Intervention with childJob DutiesActivityOther (specify in detail below)Initials of child involved in intervention (skip if not applicable)Description of event that caused the injury. Include comments and/or instructions from nurse consultation (if applicable) *I plan to seek outside medical care for this injury. *YesNoWitness(es) to Event *Supervisor of Author *Submit
