Illness/Injury Reporting Log
For Poughkeepsie Farm Project. Please see the food safety plan for overall illness/injury reporting procedures.
Date of illness/injury
*
-
Month
-
Day
Year
Date
Name of ill/injured person
*
First Name
Last Name
Injury/illness reported
*
Action taken
*
Were any emergency services required and if so, which ones?
Did the injured/ill person return to work?
*
Yes
No
Your Name
First Name
Last Name
Submit
Should be Empty: