To be completed by staff within 2 Hours of incidents/accidents (where possible)

Your name

Please make sure you provide a detailed report:

Name of person reported to in the office

Body map to show the Nature and Extent of any injuries

Name of vulnerable person

These diagrams are designed to help you record any visible signs of harm or injury. Shade and label and bruises, cuts, burns and so on. Label any parts of the body where any internal injuries have been identified as a result of a medical examination. If injuries are evident in soft0tissue parts of the body, such as the neck, under arms, stomach, genitals or inner thighs, these are unlikely to have occurred as a result of a fall or accident.


Do not worry if this information is not available at this stage it can be documented as part of the investigation. If that is more appropriate.

Name of person who completed the form