Tool 5 of 7 · Record first aid incidents

First aid record

Every injury that’s reported or treated needs a first aid record. Fill one in here, see it checked against what WSBC expects, and find out in a minute whether the employer also has to report it to WSBC.

Checked against WSBC on September 25, 2026 · Read the WSBC source page ↗

Private by design. Nothing you type here is saved or sent anywhere. The PDF is made on your device, and everything is gone when you close the tab. Keep the finished record at the workplace, confidential, for at least 3 years.

Record

Company / workplaceSequence no.Your own numbering

Worker

Full name *Occupation *

When

Date of injury, exposure or illness *Time *Date reported to the employer *Time reported *

Reported to

What happenedHow did it happen? *What happened, in the worker's words and yours.What did you see? (signs and symptoms) *Record what you observed and what the worker told you, objectively.The worker refused treatmentWhat did you do? (treatment given) *Witnesses *Names, or type “none”

Arrangements *

NotesWhere they went, how, who went with them, follow-up plan

Gave the worker a handout

Discussed return-to-work

Sent a form with the worker to medical aid

Sign-offAttendant or first aider name *If the worker can't sign, note whye.g. transported by ambulance

Signatures go on the PDF. The attendant signs, and the worker too if possible.

How will you sign it?

Complete against G3.19

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Worker's full name and occupation
Date and time of the injury, or of the report of an exposure or illness
Date and time it was reported to the employer
Names of witnesses
How it happened
The nature of the injury, exposure or illness
Treatment given and arrangements made (return to work, medical aid, ambulance, follow-up)
Any later treatment for the same injury · only for follow-up visits
Signature (or equivalent) of the attendant or first aider, and of the worker if possible

Reporting to WSBC

Tick any that apply to see if this is reportable.

Lost consciousnessSent or advised to get medical treatmentObviously needs medical treatmentWorker says they'll see a doctorWorker has had medical treatmentCan't do their usual job on a later workdayBroke glasses, dentures, a hearing aid or artificial limbWorker or WSBC asked for a report

How will you sign it?

Prefer WSBC’s own form? Download Form 55B23 ↗. Don’t send first aid records to WSBC unless they ask.

This tool explains the rules. It is not the rules.It’s built from WSBC’s first aid pages, the Occupational Health and Safety Regulation (Part 3 and Schedule 3-A) and WSBC’s OHS Guidelines. Where we say Law, the Regulation requires it. Where we say Guidance, it’s WSBC’s interpretation or advice. If anything here differs from WSBC, WSBC is right. Alpha Training Solutions is an approved first aid training provider; this toolkit is our own work and is not made or endorsed by WSBC.