Injury Report Form

Injury Report Form
Pursuant to Commission Regulation 1052 Requirements for Course Certification Section (a)(9)(D)(2),
‘The POST Regional Consultant shall be notified in writing within five (5) business days of the injury requiring more than basic first aid during training.’

For basic courses, pursuant to Commission Regulation 1059 Requirements for Basic Course Certification,
'The POST Basic Training Bureau shall be notified in writing within five (5) business days when an injury requiring more than basic first aid occurs during training.'

Please submit the information requested below to satisfy the reporting requirements:
Course Information
Presenter Name
Course Type

Basic Course (Including Regular Basic Course, Specialized Investigator's Basic Course, Modules I, II, and III, Requalification, and PC 832)
In-Service
Dispatch
Course Title
Course Start Date
Month - Day - Year
Course Control Number (14-digits: XXXX-XXXXX-XX-XXX)
Course Instructor Name
Select the POST Region Where the Course Took Place
Course Coordinator Contact Information
Name
Email
Contact Number
Phone Number
Incident Information
Type of Injury

Major
Minor
Incident Relates to Which Learning Domain?
Date of Incident
Month - Day - Year
Time of Incident
Which Part of the Body was Injured?
Please Provide the Address of Where the Incident Took Place
Please Describe the Extent of the Injury
Please Describe How the Injury Occurred
Gender

Female
Male
Other
Prefer Not to Disclose
Student Status
Reasonable Accommodation Plan
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